Article Abstract

Effects exerted by phosphodiesterase-5 inhibition on some clinical, ergospirometric and hemodynamic outcomes in chronic heart failure: a meta-analysis

Authors: Renato De Vecchis, Arturo Cesaro, Carmelina Ariano


Background: Phosphodiesterase-5 inhibitors (PDE5i) have proven to bring substantial clinical benefits for patients with pulmonary arterial hypertension. Moreover, some studies would have demonstrated useful repercussions of PDE5i use even on the clinical picture of the pulmonary hypertension (PH) secondary to left-sided chronic heart failure (CHF).
Methods: We carried out a meta-analysis including randomized controlled trials (RCTs) which had compared PDE5i (mostly sildenafil) with placebo in CHF patients.
Results: Fourteen studies comprising 928 patients in all were incorporated into the meta-analysis. In heart failure with reduced left ventricular ejection fraction (HFREF), PDE5i, compared to placebo, significantly improved the composite of death and hospitalization [odds ratio (OR) =0.28; 95% confidence interval (CI): 0.10 to 0.74]. They also improved peak VO2 [difference in means (MD): 3.76; 95% CI: 3.27 to 4.25], 6-minute walk distance (6MWD) (MD, 22.7 meters; 95% CI: 8.19 to 37.21) and pulmonary arterial systolic pressure (PASP) (MD: −11.52 mmHg; 95% CI: −15.56 to −7.49). Contrariwise, in CHF with preserved left ventricular ejection fraction (HFpEF), PDE5i proved not to bring any significant improvement of the explored endpoints.
Conclusions: In HFREF, PDE5i showed beneficial effects on the composite of death and hospitalization, as well as on exercise capacity and pulmonary hemodynamics. On the contrary, in HFpEF, no significant clinical, ergospirometric or hemodynamic improvement was obtained using PDE5i treatment.


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