PMID- 22791658
OWN - NLM
STAT- MEDLINE
DCOM- 20130115
LR  - 20121115
IS  - 1468-201X (Electronic)
IS  - 1355-6037 (Linking)
VI  - 98
IP  - 23
DP  - 2012 Dec
TI  - Aldosterone antagonists improve ejection fraction and functional capacity 
      independently of functional class: a meta-analysis of randomised controlled 
      trials.
PG  - 1693-700
LID - 10.1136/heartjnl-2012-302178 [doi]
AB  - CONTEXT: Current guidelines recommend the use of aldosterone antagonists (AA) in 
      patients with moderately severe to severe symptoms [New York Heart Association 
      (NYHA) class III to IV] and systolic heart failure. OBJECTIVE: To determine the 
      efficacy of AA in improving ejection fraction (EF) and functional capacity and to 
      assess whether this effect was influenced by baseline NYHA classification. STUDY 
      DESIGN: Meta-analysis of randomized controlled trials. Data extraction performed 
      independently by two researchers. DATA SOURCES: MEDLINE and the Cochrane Library. 
      STUDY SELECTION: Prospective randomized controlled trials using AA were included 
      if there was a clear description of the baseline NYHA classification and change 
      in EF in patients from study initiation to completion. RESULTS: Data from 1,575 
      patients enrolled in fourteen studies were included. Overall, there was a 
      weighted mean improvement in EF of 3.2% and in NYHA classification of 0.13 in 
      subjects treated with AA when compared to controls (p<0.001). A mixed effects 
      meta-regression analysis revealed that baseline NYHA was not predictive of 
      improvement in EF (p=0.67) nor NYHA status (p=0.18). CONCLUSIONS: The results of 
      this meta-analysis suggest that AA is associated with significant improvements in 
      EF and functional class independent of baseline functional capacity. This 
      supports and expands on the recently published EMPHASIS-HF trial and suggests 
      that the current restriction of AA use to patients with NYHA class III-IV 
      symptoms should be reconsidered.
FAU - Phelan, Dermot
AU  - Phelan D
AD  - Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart 
      and Vascular Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, 
      USA.
FAU - Thavendiranathan, Paaladinesh
AU  - Thavendiranathan P
FAU - Collier, Patrick
AU  - Collier P
FAU - Marwick, Thomas H
AU  - Marwick TH
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
DEP - 20120712
PL  - England
TA  - Heart
JT  - Heart (British Cardiac Society)
JID - 9602087
RN  - 0 (Mineralocorticoid Receptor Antagonists)
SB  - IM
MH  - Heart Failure/*drug therapy/physiopathology
MH  - Humans
MH  - Mineralocorticoid Receptor Antagonists/*therapeutic use
MH  - *Randomized Controlled Trials as Topic
MH  - Stroke Volume/drug effects/*physiology
MH  - Treatment Outcome
MH  - Ventricular Function/*drug effects/physiology
EDAT- 2012/07/14 06:00
MHDA- 2013/01/16 06:00
CRDT- 2012/07/14 06:00
PHST- 2012/07/14 06:00 [entrez]
PHST- 2012/07/14 06:00 [pubmed]
PHST- 2013/01/16 06:00 [medline]
AID - heartjnl-2012-302178 [pii]
AID - 10.1136/heartjnl-2012-302178 [doi]
PST - ppublish
SO  - Heart. 2012 Dec;98(23):1693-700. doi: 10.1136/heartjnl-2012-302178. Epub 2012 Jul 
      12.