Efficacy and safety of spironolactone in the heart failure with mid-range ejection fraction and heart failure with preserved ejection fraction

Figures

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  Figure 1. Quality assessment of each included study.

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  Figure 2. Forest plot of hospitalizations and functional capacity outcomes. (A) Mortality. (B) Hospitalizations. (C) New York Heart Association functional classifications (NYHA-FC). (D) Six-minute walking distance (6-MWD). All were assessed using fixed effects analyses. Squares indicated the risk ratio, odds ratio, or standard weighted mean difference; the horizontal lines indicated the 95% confidence intervals for each included trial. The statistical weight of a trial in the meta-analysis was proportional to the size of each square; diamonds indicated pooled risk ratios and 95% confidence intervals, with the center indicating the point estimate and the left and the right ends indicated the 95% confidence interval.

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  Figure 3. Forest plot of serum indicator outcomes and Echo indexes of diastolic function. (A) Procollagen type I C-terminal propeptide. (B) Amino-terminal peptide of procollagen type-III. (C) Brain natriuretic peptide (BNP). (D) Early diastolic mitral valve blood flow velocity and the early diastolic mitral valve ring motion velocity (E/e’). (E) The ratio of early to late diastolic transmitral flow (E/A ratio). The BNP and E/A ratio analysis involved a random effects model; the other three employed fixed effects analyses. The squares indicated the mean difference or standard weighted mean difference and the horizontal lines indicated the 95% confidence intervals (CI) for each trial included. The statistical weight of a trial in the meta-analysis was proportional to the size of each square; diamonds indicated pooled risk ratios and 95% CI, with the center indicating the point estimate and the left and the right ends representing the 95% CI. LVEF: Left ventricular ejection fraction.

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  Figure 4. Forest plots for echo indexes of cardiac structure and function and adverse events. (A) Left ventricular ejection fraction (LVEF). (B) Left ventricular end-diastolic dimension (LVEDD). (C) Serum potassium. (D) Hyperkalemia. (E) Gynecomastia. The LVEF and LVEDD analysis used random effects analyses, the others employed fixed effects model analyses. The squares indicated the mean difference, standard weighted mean difference or odds ratio and the horizontal lines indicated the 95% confidence intervals (CI) for each included trial. The statistical weight of a trial in the meta-analysis was proportional to the size of each square; diamonds indicate pooled risk ratios and 95% CI, with the centers indicating the point estimates and the left and the right ends representing the 95% CI. LVEF: Left ventricular ejection fraction.