Effect of Sacubitril/Valsartan on the Right Ventricular Function and Pulmonary Hypertension in Patients With Heart Failure With Reduced Ejection Fraction: A Systematic Review and Meta‐Analysis of Observational Studies
Background Sacubitril/valsartan (S/V) demonstrated significant effects in improving left ventricular performance and remodeling in patients with heart failure with reduced ejection fraction. However, its effects on the right ventricle remain unclear. This systematic review and meta‐analysis aimed to...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2022-05-01
|
| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.121.024449 |
| _version_ | 1798035935731908608 |
|---|---|
| author | Jing Zhang Le Du Xiaohan Qin Xiaoxiao Guo |
| author_facet | Jing Zhang Le Du Xiaohan Qin Xiaoxiao Guo |
| author_sort | Jing Zhang |
| collection | DOAJ |
| description | Background Sacubitril/valsartan (S/V) demonstrated significant effects in improving left ventricular performance and remodeling in patients with heart failure with reduced ejection fraction. However, its effects on the right ventricle remain unclear. This systematic review and meta‐analysis aimed to assess the impact of S/V on right ventricular function and pulmonary hypertension. Methods and Results We searched PubMed, Embase, Cochrane Library, and Web of Science from January 2010 to April 2021 for studies reporting right ventricular and pulmonary pressure indexes following S/V treatment. The quality of included studies was assessed using the Newcastle‐Ottawa scale. Variables were pooled using a random‐effects model to estimate weighted mean differences with 95% CIs. We identified 10 eligible studies comprising 875 patients with heart failure with reduced ejection fraction (mean age, 62.2 years; 74.0% men), all of which were observational. Significant improvements on right ventricular function and pulmonary hypertension after S/V initiation were observed, including tricuspid annular plane systolic excursion (weighted mean difference, 1.26 mm; 95% CI, 0.33–2.18 mm; P=0.008), tricuspid annular peak systolic velocity (weighted mean difference, 0.85 cm/s; 95% CI, 0.25–1.45 cm/s; P=0.005), and systolic pulmonary arterial pressure (weighted mean difference, 7.21 mm Hg; 95% CI, 5.38–9.03 mm Hg; P<0.001). Besides, S/V had a significant beneficial impact on left heart function, which was consistent with previous studies. The quadratic regression model revealed a certain correlation between tricuspid annular plane systolic excursion and left ventricular ejection fraction after excluding the inappropriate data (P=0.026). Conclusions This meta‐analysis verified that S/V could improve right ventricular performance and pulmonary hypertension in heart failure with reduced ejection fraction, which did not seem to be fully dependent on the reverse remodeling of left ventricle. Registration URL: https://www.crd.york.ac.uk/prospero; Unique identifier: CRD42021247970. |
| first_indexed | 2024-04-11T21:04:09Z |
| format | Article |
| id | doaj.art-c578bae924934a4fb39be676fc4200b6 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-11T21:04:09Z |
| publishDate | 2022-05-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-c578bae924934a4fb39be676fc4200b62022-12-22T04:03:23ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802022-05-0111910.1161/JAHA.121.024449Effect of Sacubitril/Valsartan on the Right Ventricular Function and Pulmonary Hypertension in Patients With Heart Failure With Reduced Ejection Fraction: A Systematic Review and Meta‐Analysis of Observational StudiesJing Zhang0Le Du1Xiaohan Qin2Xiaoxiao Guo3Department of Cardiology Peking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical College Beijing ChinaDepartment of Cardiology Peking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical College Beijing ChinaDepartment of Cardiology Peking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical College Beijing ChinaDepartment of Cardiology Peking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical College Beijing ChinaBackground Sacubitril/valsartan (S/V) demonstrated significant effects in improving left ventricular performance and remodeling in patients with heart failure with reduced ejection fraction. However, its effects on the right ventricle remain unclear. This systematic review and meta‐analysis aimed to assess the impact of S/V on right ventricular function and pulmonary hypertension. Methods and Results We searched PubMed, Embase, Cochrane Library, and Web of Science from January 2010 to April 2021 for studies reporting right ventricular and pulmonary pressure indexes following S/V treatment. The quality of included studies was assessed using the Newcastle‐Ottawa scale. Variables were pooled using a random‐effects model to estimate weighted mean differences with 95% CIs. We identified 10 eligible studies comprising 875 patients with heart failure with reduced ejection fraction (mean age, 62.2 years; 74.0% men), all of which were observational. Significant improvements on right ventricular function and pulmonary hypertension after S/V initiation were observed, including tricuspid annular plane systolic excursion (weighted mean difference, 1.26 mm; 95% CI, 0.33–2.18 mm; P=0.008), tricuspid annular peak systolic velocity (weighted mean difference, 0.85 cm/s; 95% CI, 0.25–1.45 cm/s; P=0.005), and systolic pulmonary arterial pressure (weighted mean difference, 7.21 mm Hg; 95% CI, 5.38–9.03 mm Hg; P<0.001). Besides, S/V had a significant beneficial impact on left heart function, which was consistent with previous studies. The quadratic regression model revealed a certain correlation between tricuspid annular plane systolic excursion and left ventricular ejection fraction after excluding the inappropriate data (P=0.026). Conclusions This meta‐analysis verified that S/V could improve right ventricular performance and pulmonary hypertension in heart failure with reduced ejection fraction, which did not seem to be fully dependent on the reverse remodeling of left ventricle. Registration URL: https://www.crd.york.ac.uk/prospero; Unique identifier: CRD42021247970.https://www.ahajournals.org/doi/10.1161/JAHA.121.024449heart failuremeta‐analysispulmonary hypertensionright heart functionsacubitril/valsartan |
| spellingShingle | Jing Zhang Le Du Xiaohan Qin Xiaoxiao Guo Effect of Sacubitril/Valsartan on the Right Ventricular Function and Pulmonary Hypertension in Patients With Heart Failure With Reduced Ejection Fraction: A Systematic Review and Meta‐Analysis of Observational Studies Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease heart failure meta‐analysis pulmonary hypertension right heart function sacubitril/valsartan |
| title | Effect of Sacubitril/Valsartan on the Right Ventricular Function and Pulmonary Hypertension in Patients With Heart Failure With Reduced Ejection Fraction: A Systematic Review and Meta‐Analysis of Observational Studies |
| title_full | Effect of Sacubitril/Valsartan on the Right Ventricular Function and Pulmonary Hypertension in Patients With Heart Failure With Reduced Ejection Fraction: A Systematic Review and Meta‐Analysis of Observational Studies |
| title_fullStr | Effect of Sacubitril/Valsartan on the Right Ventricular Function and Pulmonary Hypertension in Patients With Heart Failure With Reduced Ejection Fraction: A Systematic Review and Meta‐Analysis of Observational Studies |
| title_full_unstemmed | Effect of Sacubitril/Valsartan on the Right Ventricular Function and Pulmonary Hypertension in Patients With Heart Failure With Reduced Ejection Fraction: A Systematic Review and Meta‐Analysis of Observational Studies |
| title_short | Effect of Sacubitril/Valsartan on the Right Ventricular Function and Pulmonary Hypertension in Patients With Heart Failure With Reduced Ejection Fraction: A Systematic Review and Meta‐Analysis of Observational Studies |
| title_sort | effect of sacubitril valsartan on the right ventricular function and pulmonary hypertension in patients with heart failure with reduced ejection fraction a systematic review and meta analysis of observational studies |
| topic | heart failure meta‐analysis pulmonary hypertension right heart function sacubitril/valsartan |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.121.024449 |
| work_keys_str_mv | AT jingzhang effectofsacubitrilvalsartanontherightventricularfunctionandpulmonaryhypertensioninpatientswithheartfailurewithreducedejectionfractionasystematicreviewandmetaanalysisofobservationalstudies AT ledu effectofsacubitrilvalsartanontherightventricularfunctionandpulmonaryhypertensioninpatientswithheartfailurewithreducedejectionfractionasystematicreviewandmetaanalysisofobservationalstudies AT xiaohanqin effectofsacubitrilvalsartanontherightventricularfunctionandpulmonaryhypertensioninpatientswithheartfailurewithreducedejectionfractionasystematicreviewandmetaanalysisofobservationalstudies AT xiaoxiaoguo effectofsacubitrilvalsartanontherightventricularfunctionandpulmonaryhypertensioninpatientswithheartfailurewithreducedejectionfractionasystematicreviewandmetaanalysisofobservationalstudies |