ACE抑制剂对射血分数正常的慢性心力衰竭患者的疗效——对7项前瞻性临床研究的Meta分析

Background: The effect of ACE inhibitors on the prognosis of chronic heart failure patients with preserved left ventricular ejection fraction remains controversial. Aims: To assess the impact of ACE inhibitors on the prognosis of chronic heart failure patients with preserved left ventricular ejection fraction. Methods and results: Seven prospective studies evaluating the effect of ACE inhibitors compared to placebo or other classes of drugs, such as monotherapy or first-line therapy, on the prognosis of chronic heart failure patients with preserved left ventricular ejection fraction were included. A total of 2554 patients (mean age: 75.1 years, female: 58%) were recruited with an average follow up of 20.9 months. The primary etiology of heart failure with preserved ejection fraction was ischemic heart disease (33.7%), hypertension (69.1%) and diabetes mellitus (25.8%). Our results demonstrated that ACE inhibitors significantly reduced all-cause mortality (odds ratio, OR="0".52; 95% Confidence Interval (CI), 0.41 to 0.64; Pb0.01). Furthermore, ACE inhibitors were able to reduce heart failure related rehospitalization or treatment over 20.9 months (pb0.05) in a subgroup of patients aged over 75 years. However, death due to worsening of heart failure, heart failure related rehospitalization and any-cause readmission were not affected (OR=0.88; 95% CI: 0.66 to 1.17; P="0".37 for death due to worsening of heart failure; OR="0".81; 95% CI: 0.63 to 1.05; P="0".11 for heart failure related rehospitalization and OR="0".88; 95% CI: 0.68 to 1.14; P="0".33 for any-cause readmission, respectively). Conclusions: In patients with chronic heart failure with preserved ejection fraction, ACE inhibitors reduced all-cause mortality without affecting mortality due to heart failure and any-cause rehospitalization.