The Effect Of Pharmacotherapy On The Quality Of Life And Left Ventricular Diastolic Function In Diastolic Heart Failure

Objective: This study was designed to evaluate the effects of pharmacotherapy on the quality of life and left ventricular diastolic function in diastolic heart failure.Methods: From January 2000 to October 2015, we searched the Pub Med, Cochrane Library and Clinical Trials for English-language trials using the following key terms: i) preserved left ventricular function, preserved ejection fraction, heart failure with normal ejection fraction, diastolic heart failure, heart failure with preserved left ventricular; ii)randomized controlled trials; iii)Therapy, treatment. The trials conforming to the inclusion and exclusion criteria were selected by screening the titles, the abstracts and full tests of all articles. To further identify all eligible trials, checking the reference lists of the relevant reviews was performed. The quality of the included trials was assessed by Jadad’s method. Data from each trial was then extracted using a standardized form. Statistical analysis was completed using STATA, version 13.1.Results: Fifteen randomized controlled trials(RCTs) were selected by screening the titles, the abstracts and the full tests of all articles. But one study showed the significant decrease in the statistical power on account of high drop-out rate and another study had failed to provide the available information. Finally, thirteen trials were eligible and included in this meta-analysis. Effect of treatment on the quality of lifeThree indexes were applied to evaluate the quality of life. There were no statistical differences in changes of 6-minute walk distances and quality of life scores between groups( 6-min walk distances: SMD=-0.103, 95%CI[-0.246,0.040], P=0.16; quality of life scores: SMD=-0.068, 95%CI[-0.189,0.053], P=0.27). However, exercise time of patients in the treatment group was longer than in the control group after the follow-up period(SMD=0.223, 95%CI[0.006,0.439], P=0.04). Effect of treatment on left ventricular diastolic functionChanges in isovolumetric relaxation time(IVRT), left ventricular mass and the ratio of E and A(E/A) during follow-up were not significantly different between the two groups(IVRT: SMD=0.090, 95%CI[-0.090,0.260], P=0.33; left ventricular mass: SMD=-0.007, 95%CI[-0.172,0.158], P=0.94; E/A: WMD=0.006, 95%CI[-0.035,0.047], P=0.77), but left ventricular end-diastolic diameter(LVEDD), deceleration time(DT) and the ratio of E and e’(E/e’) decreased significantly in the treatment group compared with the control group(LVEDD: SMD=-0.160, 95%CI[-0.289,-0.034], P=0.01; DT: SMD=-0.181, 95%CI[-0.356,-0.006], P=0.04; E/e’: SMD=-0.160, 95%CI[-0.280,-0.040], P=0.01).Conclusion: Regarding the assessment of the quality of life, changes of 6-minute walk distances and quality of life scores had no significant differences while exercise time of patients increased in the treatment group compared with the control group. Regarding the assessment of left ventricular diastolic function, changes in IVRT, E/A and left ventricular mass were not significantly different but left ventricular end-diastolic diameter(LVEDD), deceleration time(DT) and the ratio of E and e’ decreased in the treatment group compared with the control group.