在心力衰竭中溶解的瓜尼拉特循环刺激剂与保留的排泄小部分:系统性审查和元分析
Yang Zhao1, Bin Zang1, Qian Wang2
1Department of Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, China.
Shock (Augusta, Ga.)
|November 27, 2023
概括
溶性酸环酶 (sGC) 刺激剂并没有改善心力衰竭患者的死亡率或生活质量,这些患者有保存的喷射分数 (HFpEF). 这些药物增加了不良事件,因此在HFpEF治疗中需要谨慎使用.
科学领域:
- 心脏病学 心脏病学
- 药理学 药理学是指药理学的学科.
- 临床试验 临床试验
背景情况:
- 保存喷射分数 (HFpEF) 的心力衰竭是一个重要的治疗挑战.
- 溶性酸环酶 (sGC) 刺激剂是研究用于HFpEF治疗的一类药物.
- 关于它们在HFpEF中的有效性和安全性的证据仍在评估中.
研究的目的:
- 在HFpEF患者中系统地审查和元分析sGC刺激剂的治疗疗效和安全性.
- 评估sGC刺激剂对死亡率,生活质量和功能能力的影响.
- 在HFpEF中评估与sGC刺激器使用相关的药物相关不良事件的发生率.
主要方法:
- 在PubMed,Embase和Cochrane图书馆系统地搜索随机对照试验的文献.
- 包括对HFpEF患者的sGC刺激剂与安慰剂进行比较的研究.
- 应用随机效应模型对死亡率,生活质量 (堪萨斯市心肌病问卷),6分钟步行距离和不良事件进行元分析.
主要成果:
- 包括五项研究,包括1600名HFpEF患者.
- 死亡率没有显著差异 (RR [95% CI] = 1.44 [0.71 到 2.91],P = 0.31).
- 生活质量得分或6分钟步行距离没有显著改善.
- 使用sGC刺激剂观察到与药物相关的不良事件增加 (RR [95% CI] = 1.63 [1.25-2.14],P < 0.05).
结论:
- 在HFpEF中,口服sGC刺激剂对死亡率,功能能力或生活质量没有显著的好处.
- sGC刺激剂与与药物相关的不良事件的发生率较高有关.
- 建议在HFpEF患者使用sGC刺激剂时谨慎考虑,因为观察到的风险-益处概况.
相关概念视频
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
436
The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
436
01:26Heart Failure Drugs: Inotropic Agents
594
Positive inotropic agents are commonly used as the first line of treatment for heart failure. One such agent is digoxin, derived from the genus Digitalis, which has been known for centuries but effectively utilized since 1785. However, these cardiac glycosides can have potentially toxic effects due to their mechanism of action, which involves inhibiting Na+/K+-ATPase and increasing contractility. Digoxin is absorbed orally and distributed in various tissues, including the CNS. It has a long...
594
01:22Heart Failure Drugs: β-Blockers
342
β-adrenergic antagonists, commonly known as β-blockers, block the effects of sympathetic neurotransmitters such as noradrenaline (NA) and adrenaline (ADR). They have several beneficial effects in heart failure treatment. They reduce heart rate, the force of contraction, and cardiac muscle relaxation. They also slow the atrial-ventricular conduction rate and raise the threshold for arrhythmias. The concentration of β-blockers determines their effects on bronchodilation,...
342
01:22Heart Failure Drugs: Diuretics
396
Heart failure and kidney perfusion are interconnected in a complex way. Reduced renal perfusion and venous congestion are two significant factors that contribute to renal dysfunction in heart failure. The kidneys, primarily responsible for fluid balance in the body, are adversely affected due to compromised cardiac output and increased venous pressure. In response to reduced renal perfusion, the kidneys activate neurohumoral mechanisms to restore balance. However, these mechanisms can be...
396
01:27Transducer Mechanism: Enzyme-Linked Receptors
2.5K
Enzyme-linked receptors are cell-surface receptors acting as an enzyme or associating with an enzyme intracellularly. They make excellent drug targets. Drugs can bind to the extracellular ligand-binding domain or directly affect their enzymatic domain and alter their activity.
Major types that are helpful drug targets include:
Major types that are helpful drug targets include:
2.5K
01:17Pathophysiology of Heart Failure
1.6K
Heart failure (HF) is a progressive syndrome involving ventricles that leads to inadequate cardiac output. It can be classified based on location and output or ejection fraction. Ejection fraction (EF) is an essential measurement in the diagnosis and surveillance of HF. Reduced EF corresponds to systolic heart failure (HFrEF). However, HF with preserved ejection fraction (HFpEF) is becoming increasingly prevalent. Also known as diastolic HF, this form of HF is related to aging. The...
1.6K