title: Impact of mineralocorticoid receptor antagonists on changes in cardiac structure and function of left ventricular dysfunction: a meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  A comprehensive evaluation of the benefits of mineralocorticoid receptor antagonists on cardiac remodeling is lacking. We aimed to evaluate the impact of mineralocorticoid receptor antagonists on changes in cardiac structure and function of left ventricular dysfunction.
  
  
  RESULTS
  Articles were identified by online searches in PubMed, EMBASE, Cochrane, and ClinicalTrials.gov databases before June 2012, by hand searches of reviews and relevant journals, and by contact with the authors. Qualified articles were restricted to randomized controlled trials. There were, respectively, 12, 4, and 3 qualified trials that randomized 572, 647, and 407 patients to spironolactone, canrenoate, and eplerenone, and 531, 655, and 395 patients to placebo or active treatment, respectively. Overall, under mineralocorticoid receptor antagonist treatment there was improvement in left ventricular ejection fraction (weighted mean difference, 2.97; 95% confidence interval [95% CI], 2.26-3.67; P<0.0005), left ventricular end-systolic and end-diastolic volume index (weighted mean difference, -5.64; 95% CI, -7.94 to -3.34; P<0.0005 and weighted mean difference, -7.46; 95% CI, -11.63 to -3.3; P<0.0005), serum amino-terminal peptide of procollagen type-III (weighted mean difference, -1.12; 95% CI, -1.49 to -0.74; P<0.0005), B-type natriuretic peptide (weighted mean difference, -67.06; 95% CI, -91.24 to -42.88; P<0.0005), peak velocities of early mitral inflow (E; weighted mean difference, -9.57; 95% CI, -12.98 to -6.17; P<0.0005), and E wave deceleration time (weighted mean difference, 7.08; 95% CI, 4.07-10.09; P<0.0005). There was low probability of heterogeneity and publication bias.
  
  
  CONCLUSIONS
  Our findings demonstrate that mineralocorticoid receptor antagonist treatment may exert beneficial effects on the reversal of cardiac remodeling and improvement of left ventricular function.
authors: State Key Laboratory of Medical Genomics, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
authors: Xiaobo
authors: X
authors: Li
authors: Yue
authors: Y
authors: Qi
authors: Yuqiong
authors: Y
authors: Li
authors: Shanshan
authors: S
authors: Zhang
authors: Shujie
authors: S
authors: Guo
authors: Shaoli
authors: S
authors: Chu
authors: Pingjin
authors: P
authors: Gao
authors: Dingliang
authors: D
authors: Zhu
authors: Zhijun
authors: Z
authors: Wu
authors: Lin
authors: L
authors: Lu
authors: Weifeng
authors: W
authors: Shen
authors: Nan
authors: N
authors: Jia
authors: Wenquan
authors: W
authors: Niu
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use*; D008943:Mitral Valve / Q000187:drug effects / Q000503:physiopathology; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011347:Procollagen / Q000097:blood; D016032:Randomized Controlled Trials as Topic; D020127:Recovery of Function; D013318:Stroke Volume / Q000187:drug effects; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D016277:Ventricular Function, Left / Q000187:drug effects*; D020257:Ventricular Remodeling / Q000187:drug effects*
chemical_list: D015415:Biomarkers; D000451:Mineralocorticoid Receptor Antagonists; D010446:Peptide Fragments; D011347:Procollagen; C041876:procollagen Type III-N-terminal peptide; D020097:Natriuretic Peptide, Brain