Efficacy of Beta-Blockers and Angiotensin-Converting Enzyme Inhibitors in Non-Ischemic Dilated Cardiomyopathy: A Systematic Review and Meta-Analysis.

IF 1.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiology Research Pub Date : 2024-08-01 Epub Date: 2024-07-18 DOI:10.14740/cr1653

Jordan Llerena-Velastegui, Melisa Santamaria-Lasso, Melany Mejia-Mora, Mauricio Santander-Aldean, Andrea Granda-Munoz, Claudia Hurtado-Alzate, Ana Clara Fonseca Souza de Jesus, Jurgen Baldelomar-Ortiz

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引用次数: 0

Abstract

Background: Non-ischemic dilated cardiomyopathy (NIDCM) is a form of heart failure with a poor prognosis and unclear optimal management. The aim of the study was to systematically review the literature and assess the efficacy and safety of beta-blockers and angiotensin-converting enzyme (ACE) inhibitors in the management of chronic heart failure secondary to NIDCM and explore their putative mechanisms of action.

Methods: Studies from 1990 to 2023 were reviewed using PubMed and EMBASE, focusing on their effects on left ventricular ejection fraction (LVEF) in NIDCM patients, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Results: Beta-blockers showed a significant beneficial effect on LVEF improvement in NIDCM, with an overall effect size of Cohen's d = 1.30, 95% confidence interval (CI) (0.76, 1.84), high heterogeneity (Tau² = 0.90; Chi² = 162.05, df = 13, P < 0.00001; I² = 92%), and a significant overall effect (Z = 4.72, P < 0.00001). ACE inhibitors also showed a beneficial role, but with less heterogeneity (Tau² = 0.02; Chi² = 1.09, df = 1, P = 0.30; I² = 8%) and a nonsignificant overall effect (Z = 1.36, P = 0.17), 95% CI (-0.24, 1.31).

Conclusions: The study highlights the efficacy of carvedilol in improving LVEF in NIDCM patients over ACE inhibitors, recommends beta-blockers as first-line therapy, and advocates further research on ACE inhibitors.

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β-受体阻滞剂和血管紧张素转换酶抑制剂对非缺血性扩张型心肌病的疗效：系统回顾与元分析》。

背景：非缺血性扩张型心肌病（NIDCM）是一种预后不良、最佳治疗方法不明确的心力衰竭。本研究旨在系统回顾文献，评估β-受体阻滞剂和血管紧张素转换酶（ACE）抑制剂在治疗 NIDCM 继发性慢性心力衰竭中的疗效和安全性，并探讨其可能的作用机制：根据系统综述和荟萃分析首选报告项目（Preferred Reporting Items for Systematic Reviews and Meta-Analyses，PRISMA）指南，使用 PubMed 和 EMBASE 对 1990 年至 2023 年的研究进行了综述，重点关注它们对 NIDCM 患者左心室射血分数（LVEF）的影响：贝塔受体阻滞剂对改善 NIDCM 患者的 LVEF 有显著的有益作用，其总体效应大小为 Cohen's d = 1.30，95% 置信区间 (CI) (0.76, 1.84)，异质性较高 (Tau2 = 0.90; Chi2 = 162.05, df = 13, P < 0.00001; I2 = 92%)，总体效应显著 (Z = 4.72, P < 0.00001)。ACE 抑制剂也显示出有益作用，但异质性较小（Tau2 = 0.02；Chi2 = 1.09，df = 1，P = 0.30；I2 = 8%），总体效果不显著（Z = 1.36，P = 0.17），95% CI (-0.24, 1.31)：该研究强调了卡维地洛改善 NIDCM 患者 LVEF 的疗效优于 ACE 抑制剂，建议将β-受体阻滞剂作为一线治疗药物，并提倡对 ACE 抑制剂进行进一步研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cardiology Research CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

2.50

自引率

0.00%

发文量

期刊介绍： Cardiology Research is an open access, peer-reviewed, international journal. All submissions relating to basic research and clinical practice of cardiology and cardiovascular medicine are in this journal''s scope. This journal focuses on publishing original research and observations in all cardiovascular medicine aspects. Manuscript types include original article, review, case report, short communication, book review, letter to the editor.