Efficacy and safety of inorganic nitrate/nitrite supplementary therapy in heart failure with preserved ejection fraction
BackgroundApproximately half of patients with heart failure have a preserved ejection fraction (HFpEF). To date, only SGLT-2i, ARNi, and MRAs treatments have been shown to be effective for HFpEF. Exercise intolerance is the primary clinical feature of HFpEF. The aim of this meta-analysis was to expl...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-02-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2023.1054666/full |
| _version_ | 1797935744024576000 |
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| author | Feng Lv Junyi Zhang Yuan Tao |
| author_facet | Feng Lv Junyi Zhang Yuan Tao |
| author_sort | Feng Lv |
| collection | DOAJ |
| description | BackgroundApproximately half of patients with heart failure have a preserved ejection fraction (HFpEF). To date, only SGLT-2i, ARNi, and MRAs treatments have been shown to be effective for HFpEF. Exercise intolerance is the primary clinical feature of HFpEF. The aim of this meta-analysis was to explore the effect of inorganic nitrate/nitrite supplementary therapy on the exercise capacity of HFpEF patients.MethodsWe searched PubMed, Embase, Cochrane Library, OVID, and Web of Science for eligible studies for this meta-analysis. The primary outcomes were peak oxygen consumption (peak VO2), exercise time, and respiratory exchange ratio (RER) during exercise. The secondary outcomes were cardiac output, heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, and systemic vascular resistance during rest and exercise, respectively.ResultsA total of eight randomized-controlled trials were enrolled for this meta-analysis. We found no benefit of inorganic nitrate/nitrite on exercise capacity in patients with HFpEF. Inorganic nitrate/nitrite compared to placebo, did not significantly increased peak VO2 (MD = 0.361, 95% CI = −0.17 to 0.89, p = 0.183), exercise time (MD = 9.74, 95% CI = −46.47 to 65.95, p = 0.734), and respiratory exchange ratio during exercise (MD = −0.003, 95% CI = −0.036 to 0.029, p = 0.834). Among the six diameters reflecting cardiac and artery hemodynamics, inorganic nitrate/nitrite can lower rest SBP, rest/exercise DBP, rest/exercise MAP, and exercise SVR, but has no effect in cardiac output and heart rate for HFpEF patients.ConclusionOur meta-analysis suggested that inorganic nitrate/nitrite supplementary therapy has no benefit in improving the exercise capacity of patients with HFpEF, but can yield a blood pressure lowering effect, especially during exercise. |
| first_indexed | 2024-04-10T18:18:56Z |
| format | Article |
| id | doaj.art-48bede28308f4e87bb37f5c7a3b11102 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-04-10T18:18:56Z |
| publishDate | 2023-02-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-48bede28308f4e87bb37f5c7a3b111022023-02-02T07:34:22ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2023-02-011010.3389/fcvm.2023.10546661054666Efficacy and safety of inorganic nitrate/nitrite supplementary therapy in heart failure with preserved ejection fractionFeng Lv0Junyi Zhang1Yuan Tao2Department of Cardiology, Shengzhou People’s Hospital (The First Affiliated Hospital of Zhejiang University Shengzhou Branch), Shengzhou City, Zhejiang Province, ChinaDepartment of Cardiology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou City, Jiangsu Province, ChinaDepartment of Cardiology, Shengzhou People’s Hospital (The First Affiliated Hospital of Zhejiang University Shengzhou Branch), Shengzhou City, Zhejiang Province, ChinaBackgroundApproximately half of patients with heart failure have a preserved ejection fraction (HFpEF). To date, only SGLT-2i, ARNi, and MRAs treatments have been shown to be effective for HFpEF. Exercise intolerance is the primary clinical feature of HFpEF. The aim of this meta-analysis was to explore the effect of inorganic nitrate/nitrite supplementary therapy on the exercise capacity of HFpEF patients.MethodsWe searched PubMed, Embase, Cochrane Library, OVID, and Web of Science for eligible studies for this meta-analysis. The primary outcomes were peak oxygen consumption (peak VO2), exercise time, and respiratory exchange ratio (RER) during exercise. The secondary outcomes were cardiac output, heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, and systemic vascular resistance during rest and exercise, respectively.ResultsA total of eight randomized-controlled trials were enrolled for this meta-analysis. We found no benefit of inorganic nitrate/nitrite on exercise capacity in patients with HFpEF. Inorganic nitrate/nitrite compared to placebo, did not significantly increased peak VO2 (MD = 0.361, 95% CI = −0.17 to 0.89, p = 0.183), exercise time (MD = 9.74, 95% CI = −46.47 to 65.95, p = 0.734), and respiratory exchange ratio during exercise (MD = −0.003, 95% CI = −0.036 to 0.029, p = 0.834). Among the six diameters reflecting cardiac and artery hemodynamics, inorganic nitrate/nitrite can lower rest SBP, rest/exercise DBP, rest/exercise MAP, and exercise SVR, but has no effect in cardiac output and heart rate for HFpEF patients.ConclusionOur meta-analysis suggested that inorganic nitrate/nitrite supplementary therapy has no benefit in improving the exercise capacity of patients with HFpEF, but can yield a blood pressure lowering effect, especially during exercise.https://www.frontiersin.org/articles/10.3389/fcvm.2023.1054666/fullheart failure with preserved ejection fraction (HFpEF)inorganic nitrateinorganic nitritemeta-analysisexercise capacity |
| spellingShingle | Feng Lv Junyi Zhang Yuan Tao Efficacy and safety of inorganic nitrate/nitrite supplementary therapy in heart failure with preserved ejection fraction Frontiers in Cardiovascular Medicine heart failure with preserved ejection fraction (HFpEF) inorganic nitrate inorganic nitrite meta-analysis exercise capacity |
| title | Efficacy and safety of inorganic nitrate/nitrite supplementary therapy in heart failure with preserved ejection fraction |
| title_full | Efficacy and safety of inorganic nitrate/nitrite supplementary therapy in heart failure with preserved ejection fraction |
| title_fullStr | Efficacy and safety of inorganic nitrate/nitrite supplementary therapy in heart failure with preserved ejection fraction |
| title_full_unstemmed | Efficacy and safety of inorganic nitrate/nitrite supplementary therapy in heart failure with preserved ejection fraction |
| title_short | Efficacy and safety of inorganic nitrate/nitrite supplementary therapy in heart failure with preserved ejection fraction |
| title_sort | efficacy and safety of inorganic nitrate nitrite supplementary therapy in heart failure with preserved ejection fraction |
| topic | heart failure with preserved ejection fraction (HFpEF) inorganic nitrate inorganic nitrite meta-analysis exercise capacity |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2023.1054666/full |
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