Pulmonary hypertension-targeted therapies in heart failure: A systematic review and meta-analysis.
BACKGROUND:Pulmonary hypertension (PH) due to left heart failure (HF) is the most common form of PH. However, treatment is unclear because there are conflicting results about safety and efficacy of PH-targeted therapies. OBJECTIVES:To assess the effects of PH-targeted therapy on exercise capacity in...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2018-01-01
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| Series: | PLoS ONE |
| Online Access: | http://europepmc.org/articles/PMC6181322?pdf=render |
| _version_ | 1818194975702122496 |
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| author | Charles-Antoine Guay Louis-Vincent Morin-Thibault Sebastien Bonnet Yves Lacasse Caroline Lambert Jean-Christophe Lega Steeve Provencher |
| author_facet | Charles-Antoine Guay Louis-Vincent Morin-Thibault Sebastien Bonnet Yves Lacasse Caroline Lambert Jean-Christophe Lega Steeve Provencher |
| author_sort | Charles-Antoine Guay |
| collection | DOAJ |
| description | BACKGROUND:Pulmonary hypertension (PH) due to left heart failure (HF) is the most common form of PH. However, treatment is unclear because there are conflicting results about safety and efficacy of PH-targeted therapies. OBJECTIVES:To assess the effects of PH-targeted therapy on exercise capacity in HF patients. METHODS:MEDLINE, EMBASE and the Cochrane Library were searched from January 1990 to July 2017 for randomized controlled trials comparing PH-targeted therapies to conventional therapy in HF. The primary outcome was to assess the effects on exercise capacity. Secondary outcomes included mortality, hospitalisation, NT-proBNP levels, echocardiographic and hemodynamics parameters and discontinuation rate. RESULTS:22 studies were included (n = 5448), including 3, 8 and 11 studies with low, high and unknown risk of bias, respectively. PH-targeted therapies were associated with an improvement of exercise capacity (standardized mean difference 0.29;95%CI:0.08-0.50, p = 0.006). Pre-specified subgroup analyses found that this improvement was predominantly observed in studies evaluating phosphodiesterase-5 inhibitors and prostanoids and in patients with reduced ejection fraction. Moreover, systolic pulmonary artery pressure measured by echocardiography was improved (mean difference: -7.5mmHg; [95%CI]: -14.9,-0.1, p = 0.05), which was also entirely driven by studies evaluating phosphodiesterase-5 inhibitors. However, PH-targeted therapies were associated with an increased treatment discontinuation rates and a potential increase in mortality compared to standard treatment. CONCLUSIONS:In conclusion, PH-targeted therapies and especially phosphodiesterase-5 inhibitors may improve exercise capacity in patients with HF. However, an increase in adverse outcomes was likely. Moreover, most studies were at high or unknown risk of bias, precluding confident conclusions about the effects of PH-targeted therapies. |
| first_indexed | 2024-12-12T01:10:50Z |
| format | Article |
| id | doaj.art-f9a0ae7810b04c16b66c22b34345792e |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-12T01:10:50Z |
| publishDate | 2018-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-f9a0ae7810b04c16b66c22b34345792e2022-12-22T00:43:28ZengPublic Library of Science (PLoS)PLoS ONE1932-62032018-01-011310e020461010.1371/journal.pone.0204610Pulmonary hypertension-targeted therapies in heart failure: A systematic review and meta-analysis.Charles-Antoine GuayLouis-Vincent Morin-ThibaultSebastien BonnetYves LacasseCaroline LambertJean-Christophe LegaSteeve ProvencherBACKGROUND:Pulmonary hypertension (PH) due to left heart failure (HF) is the most common form of PH. However, treatment is unclear because there are conflicting results about safety and efficacy of PH-targeted therapies. OBJECTIVES:To assess the effects of PH-targeted therapy on exercise capacity in HF patients. METHODS:MEDLINE, EMBASE and the Cochrane Library were searched from January 1990 to July 2017 for randomized controlled trials comparing PH-targeted therapies to conventional therapy in HF. The primary outcome was to assess the effects on exercise capacity. Secondary outcomes included mortality, hospitalisation, NT-proBNP levels, echocardiographic and hemodynamics parameters and discontinuation rate. RESULTS:22 studies were included (n = 5448), including 3, 8 and 11 studies with low, high and unknown risk of bias, respectively. PH-targeted therapies were associated with an improvement of exercise capacity (standardized mean difference 0.29;95%CI:0.08-0.50, p = 0.006). Pre-specified subgroup analyses found that this improvement was predominantly observed in studies evaluating phosphodiesterase-5 inhibitors and prostanoids and in patients with reduced ejection fraction. Moreover, systolic pulmonary artery pressure measured by echocardiography was improved (mean difference: -7.5mmHg; [95%CI]: -14.9,-0.1, p = 0.05), which was also entirely driven by studies evaluating phosphodiesterase-5 inhibitors. However, PH-targeted therapies were associated with an increased treatment discontinuation rates and a potential increase in mortality compared to standard treatment. CONCLUSIONS:In conclusion, PH-targeted therapies and especially phosphodiesterase-5 inhibitors may improve exercise capacity in patients with HF. However, an increase in adverse outcomes was likely. Moreover, most studies were at high or unknown risk of bias, precluding confident conclusions about the effects of PH-targeted therapies.http://europepmc.org/articles/PMC6181322?pdf=render |
| spellingShingle | Charles-Antoine Guay Louis-Vincent Morin-Thibault Sebastien Bonnet Yves Lacasse Caroline Lambert Jean-Christophe Lega Steeve Provencher Pulmonary hypertension-targeted therapies in heart failure: A systematic review and meta-analysis. PLoS ONE |
| title | Pulmonary hypertension-targeted therapies in heart failure: A systematic review and meta-analysis. |
| title_full | Pulmonary hypertension-targeted therapies in heart failure: A systematic review and meta-analysis. |
| title_fullStr | Pulmonary hypertension-targeted therapies in heart failure: A systematic review and meta-analysis. |
| title_full_unstemmed | Pulmonary hypertension-targeted therapies in heart failure: A systematic review and meta-analysis. |
| title_short | Pulmonary hypertension-targeted therapies in heart failure: A systematic review and meta-analysis. |
| title_sort | pulmonary hypertension targeted therapies in heart failure a systematic review and meta analysis |
| url | http://europepmc.org/articles/PMC6181322?pdf=render |
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