Istaroxime for Patients with Acute Heart Failure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Istaroxime, an intravenous inotropic agent with a dual mechanism—increasing both cardiomyocyte contractility and relaxation—is a novel treatment for acute heart failure (AHF), the leading cause of morbidity and mortality in heart failure. We conducted a systematic review and meta-analysis that synth...
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| Format: | Article |
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MDPI AG
2023-12-01
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| Series: | Diseases |
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| Online Access: | https://www.mdpi.com/2079-9721/11/4/183 |
| _version_ | 1827575085316177920 |
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| author | Mohamed Abuelazm Shafaqat Ali Majd M. AlBarakat Abdelrahman Mahmoud Mohammad Tanashat Husam Abu Suilik Basel Abdelazeem James Robert Brašić |
| author_facet | Mohamed Abuelazm Shafaqat Ali Majd M. AlBarakat Abdelrahman Mahmoud Mohammad Tanashat Husam Abu Suilik Basel Abdelazeem James Robert Brašić |
| author_sort | Mohamed Abuelazm |
| collection | DOAJ |
| description | Istaroxime, an intravenous inotropic agent with a dual mechanism—increasing both cardiomyocyte contractility and relaxation—is a novel treatment for acute heart failure (AHF), the leading cause of morbidity and mortality in heart failure. We conducted a systematic review and meta-analysis that synthesized randomized controlled trials (RCTs), which were retrieved by systematically searching PubMed, Web of Science, SCOPUS, and Cochrane until 24 April 2023. We used a fixed-effect or random-effect model—according to heterogeneity—to pool dichotomous data using the risk ratio (RR) and continuous data using the mean difference (MD), with a 95% confidence interval (CI). We included three RCTs with a total of 300 patients. Istaroxime was significantly associated with an increased left ventricular ejection fraction (mL) (MD: 1.06, 95% CI: 0.29, 1.82; <i>p</i> = 0.007), stroke volume index (MD: 3.04, 95% CI: 2.41, 3.67; <i>p</i> = 0.00001), and cardiac index (L/min/m<sup>2</sup>) (MD: 0.18, 95% CI: 0.11, 025; <i>p</i> = 0.00001). Also, istaroxime was significantly associated with a decreased E/A ratio (MD: −0.39, 95% CI: −0.58, −0.19; <i>p</i> = 0.0001) and pulmonary artery systolic pressure (mmHg) (MD: 2.30, 95% CI: 3.20, 1.40; <i>p</i> = 0.00001). Istaroxime was significantly associated with increased systolic blood pressure (mmHg) (MD: 5.32, 95% CI: 2.28, 8.37; <i>p</i> = 0.0006) and decreased heart rate (bpm) (MD: −3.05, 95% CI: −5.27, −0.82; <i>p</i> = 0.007). Since istaroxime improved hemodynamic and echocardiographic parameters, it constitutes a promising strategy for AHF management. However, the current literature is limited to a small number of RCTs, warranting further large-scale phase III trials before clinical endorsement. |
| first_indexed | 2024-03-08T20:51:12Z |
| format | Article |
| id | doaj.art-e735aa7e3f0e4b969aea42326adb2be2 |
| institution | Directory Open Access Journal |
| issn | 2079-9721 |
| language | English |
| last_indexed | 2024-03-08T20:51:12Z |
| publishDate | 2023-12-01 |
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| record_format | Article |
| series | Diseases |
| spelling | doaj.art-e735aa7e3f0e4b969aea42326adb2be22023-12-22T14:03:39ZengMDPI AGDiseases2079-97212023-12-0111418310.3390/diseases11040183Istaroxime for Patients with Acute Heart Failure: A Systematic Review and Meta-Analysis of Randomized Controlled TrialsMohamed Abuelazm0Shafaqat Ali1Majd M. AlBarakat2Abdelrahman Mahmoud3Mohammad Tanashat4Husam Abu Suilik5Basel Abdelazeem6James Robert Brašić7Faculty of Medicine, Tanta University, Tanta 31527, EgyptDepartment of Internal Medicine, Louisiana State University Health Shreveport, Shreveport, LA 71103, USAFaculty of Medicine, Jordan University of Science and Technology, Irbid 22110, JordanFaculty of Medicine, Minia University, Minia 61519, EgyptFaculty of Medicine, Yarmouk University, Irbid 21163, JordanFaculty of Medicine, Hashemite University, Zarqa 13133, JordanDivision of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown, WV 26506, USASection of High-Resolution Brain Positron Emission Tomography Imaging, Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USAIstaroxime, an intravenous inotropic agent with a dual mechanism—increasing both cardiomyocyte contractility and relaxation—is a novel treatment for acute heart failure (AHF), the leading cause of morbidity and mortality in heart failure. We conducted a systematic review and meta-analysis that synthesized randomized controlled trials (RCTs), which were retrieved by systematically searching PubMed, Web of Science, SCOPUS, and Cochrane until 24 April 2023. We used a fixed-effect or random-effect model—according to heterogeneity—to pool dichotomous data using the risk ratio (RR) and continuous data using the mean difference (MD), with a 95% confidence interval (CI). We included three RCTs with a total of 300 patients. Istaroxime was significantly associated with an increased left ventricular ejection fraction (mL) (MD: 1.06, 95% CI: 0.29, 1.82; <i>p</i> = 0.007), stroke volume index (MD: 3.04, 95% CI: 2.41, 3.67; <i>p</i> = 0.00001), and cardiac index (L/min/m<sup>2</sup>) (MD: 0.18, 95% CI: 0.11, 025; <i>p</i> = 0.00001). Also, istaroxime was significantly associated with a decreased E/A ratio (MD: −0.39, 95% CI: −0.58, −0.19; <i>p</i> = 0.0001) and pulmonary artery systolic pressure (mmHg) (MD: 2.30, 95% CI: 3.20, 1.40; <i>p</i> = 0.00001). Istaroxime was significantly associated with increased systolic blood pressure (mmHg) (MD: 5.32, 95% CI: 2.28, 8.37; <i>p</i> = 0.0006) and decreased heart rate (bpm) (MD: −3.05, 95% CI: −5.27, −0.82; <i>p</i> = 0.007). Since istaroxime improved hemodynamic and echocardiographic parameters, it constitutes a promising strategy for AHF management. However, the current literature is limited to a small number of RCTs, warranting further large-scale phase III trials before clinical endorsement.https://www.mdpi.com/2079-9721/11/4/183atrial fibrillationblood pressureclinical trialconfidence intervalforest plotinotropic |
| spellingShingle | Mohamed Abuelazm Shafaqat Ali Majd M. AlBarakat Abdelrahman Mahmoud Mohammad Tanashat Husam Abu Suilik Basel Abdelazeem James Robert Brašić Istaroxime for Patients with Acute Heart Failure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials Diseases atrial fibrillation blood pressure clinical trial confidence interval forest plot inotropic |
| title | Istaroxime for Patients with Acute Heart Failure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials |
| title_full | Istaroxime for Patients with Acute Heart Failure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials |
| title_fullStr | Istaroxime for Patients with Acute Heart Failure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials |
| title_full_unstemmed | Istaroxime for Patients with Acute Heart Failure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials |
| title_short | Istaroxime for Patients with Acute Heart Failure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials |
| title_sort | istaroxime for patients with acute heart failure a systematic review and meta analysis of randomized controlled trials |
| topic | atrial fibrillation blood pressure clinical trial confidence interval forest plot inotropic |
| url | https://www.mdpi.com/2079-9721/11/4/183 |
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