Key result
ACE inhibitors significantly improved NYHA class in patients with chronic heart failure compared to placebo (OR 0.875; 95% CI 0.811-0.943; p=0.0005), but not post-myocardial infarction.
Why the study?
Do ACE inhibitors improve NYHA class in patients with left ventricular systolic dysfunction?
Meta-Analysis (n=12,691)
Do ACE inhibitors improve NYHA class in patients with left ventricular systolic dysfunction?
ACE inhibitors significantly improve symptomatic status as measured by NYHA classification in patients with chronic heart failure and left ventricular systolic dysfunction.
Answers are grounded in this paper and cite their sources.
Supports ACE inhibitor use for NYHA improvement in chronic HF; confirms RCT meta-analysis benefit on symptoms in LV systolic dysfunction.
BACKGROUND: The effect of angiotensin converting enzyme (ACE) inhibitors on symptoms in patients with left ventricular systolic dysfunction (LVSD) is controversial. AIMS: To perform a meta-analysis of studies evaluating effect of ACE inhibitors on New York Heart Association (NYHA) class in patients with LVSD. METHODS: Individual data from 10389 patients in NYHA classes I-IV from four large long-term studies (2-4-year follow-up) and summary data from 2302 patients in NYHA classes II-IV from 16 short-term studies (3 months follow-up) were meta-analysed to assess changes in NYHA class. RESULTS: The large long-term studies showed a significant improvement in the worst NYHA classes (classes II-IV compared to class I) in the ACE inhibitor arm versus placebo, odds ratio (OR) = 0.875 (0.811-0.943) p = 0.0005. This effect was only present in studies which included patients with chronic heart failure and was particularly pronounced on deterioration to the worst NYHA class IV, OR = 0.66 (0.52-0.84) p = 0.001. There was no effect in the studies which included patients after myocardial infarction. The short-term chronic heart failure studies showed a significant improvement in NYHA class; OR for improvement of at least one NYHA class was 2.11 (1.48-2.98, 95% CI) p < 0.0001. CONCLUSION: ACE inhibition significantly improves symptomatic status measured as NYHA classification in patients with chronic heart failure.
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Abdulla et al. (2005) conducted a meta-analysis in Left ventricular systolic dysfunction (n=12,691). Angiotensin-converting enzyme (ACE) inhibitors vs. Placebo was evaluated on Changes in NYHA class (OR 0.875, 95% CI 0.811-0.943, p=0.0005). ACE inhibitors significantly improved NYHA class in patients with chronic heart failure compared to placebo (OR 0.875; 95% CI 0.811-0.943; p=0.0005), but not post-myocardial infarction.
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