title: Effect of Mineralocorticoid Receptor Antagonists on Cardiac Structure and Function in Patients With Diastolic Dysfunction and Heart Failure With Preserved Ejection Fraction: A Meta-Analysis and Systematic Review.
abstract: BACKGROUND
  There has been an increasing interest in use of mineralocorticoid receptor antagonists (MRAs) in patients with heart failure with preserved ejection fraction (HFPEF). However, a comprehensive evaluation of MRA effects on left ventricular (LV) structure and function in these patients is lacking. In this meta-analysis, we evaluated the effects of MRAs on LV structure and function among patients with diastolic dysfunction or HFPEF.
  
  
  RESULTS
  Randomized, controlled clinical trials evaluating the efficacy of MRAs in patients with diastolic dysfunction or HFPEF were included. The primary outcome was change in E/e', a specific measure of diastolic function. Secondary outcomes included changes in other measures of diastolic function, LV structure, surrogate markers for myocardial fibrosis (carboxy-terminal peptide of procollagen type I [PICP] and amino-terminal peptide of pro-collagen type-II [PIIINP]), blood pressure, and exercise tolerance. In the pooled analysis, MRA use was associated with significant reduction in E/e' (weighted mean difference [WMD] [95% confidence interval {CI}]: -1.68 [-2.03 to -1.33]; P<0.0001) and deceleration time (WMD [95% CI]: -12.0 ms [-23.3 to -0.7]; P=0.04) as compared with control, suggesting and improvement in diastolic function. Furthermore, blood pressure and levels of PIIINP and PICP were also significantly reduced with MRA therapy with no significant change in LV mass or dimensions.
  
  
  CONCLUSIONS
  MRA therapy in patients with asymptomatic diastolic dysfunction or HFPEF is associated with significant improvement in diastolic function and markers of cardiac fibrosis without a significant change in LV mass or dimensions.
authors.affiliation: UT Southwestern Medical Center, Dallas, TX, Australia (A.P., S.A.M., M.H.D., A.A., J.D.B., S.P.M., J.A.L., D.J.K.).
authors.forename: Ambarish
authors.initials: A
authors.lastname: Pandey
authors.affiliation: University of Minnesota Medical Center, Minneapolis, MN, Australia (S.G.).
authors.forename: Sushil
authors.initials: S
authors.lastname: Garg
authors.affiliation: UT Southwestern Medical Center, Dallas, TX, Australia (A.P., S.A.M., M.H.D., A.A., J.D.B., S.P.M., J.A.L., D.J.K.).
authors.forename: Susan A
authors.initials: SA
authors.lastname: Matulevicius
authors.affiliation: Brigham and Women's Hospital, Boston, MA, Australia (A.M.S.).
authors.forename: Amil M
authors.initials: AM
authors.lastname: Shah
authors.affiliation: New York Medical Center, Valhalla, NY, Australia (J.G.).
authors.forename: Jalaj
authors.initials: J
authors.lastname: Garg
authors.affiliation: UT Southwestern Medical Center, Dallas, TX, Australia (A.P., S.A.M., M.H.D., A.A., J.D.B., S.P.M., J.A.L., D.J.K.).
authors.forename: Mark H
authors.initials: MH
authors.lastname: Drazner
authors.affiliation: UT Southwestern Medical Center, Dallas, TX, Australia (A.P., S.A.M., M.H.D., A.A., J.D.B., S.P.M., J.A.L., D.J.K.).
authors.forename: Alpesh
authors.initials: A
authors.lastname: Amin
authors.affiliation: UT Southwestern Medical Center, Dallas, TX, Australia (A.P., S.A.M., M.H.D., A.A., J.D.B., S.P.M., J.A.L., D.J.K.).
authors.forename: Jarett D
authors.initials: JD
authors.lastname: Berry
authors.affiliation: Menzies Research Institute, University of Tasmania, Australia (T.H.M.).
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Marwick
authors.affiliation: UT Southwestern Medical Center, Dallas, TX, Australia (A.P., S.A.M., M.H.D., A.A., J.D.B., S.P.M., J.A.L., D.J.K.).
authors.forename: Steven P
authors.initials: SP
authors.lastname: Marso
authors.affiliation: UT Southwestern Medical Center, Dallas, TX, Australia (A.P., S.A.M., M.H.D., A.A., J.D.B., S.P.M., J.A.L., D.J.K.).
authors.forename: James A
authors.initials: JA
authors.lastname: de Lemos
authors.affiliation: UT Southwestern Medical Center, Dallas, TX, Australia (A.P., S.A.M., M.H.D., A.A., J.D.B., S.P.M., J.A.L., D.J.K.).
authors.forename: Dharam J
authors.initials: DJ
authors.lastname: Kumbhani
mesh_terms: D016009:Chi-Square Distribution; D003971:Diastole / Q000187:drug effects*; D005355:Fibrosis; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D000451:Mineralocorticoid Receptor Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D020127:Recovery of Function; D013318:Stroke Volume; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D016277:Ventricular Function, Left / Q000187:drug effects*; D020257:Ventricular Remodeling / Q000187:drug effects
chemical_list: D000451:Mineralocorticoid Receptor Antagonists
keywords: diastolic dysfunction; heart failure with preserved ejection fraction; mineralocorticoid receptor antagonist