Meta-Analysis Evaluates Use of Medical Therapy in Treatment of Systemic Right Ventricles

August 20, 2018—Elisa Zaragoza-Macias, MD, et al, in association with the American College of Cardiology (ACA) and American Heart Association (AHA) Task Force on Clinical Practice Guidelines published a systematic review of medical therapy for systemic right ventricles (RVs) online simultaneously in Circulation and Journal of the American College of Cardiology.

With a limited number of clinical studies evaluating the efficacy of medical therapy for systemic RV dysfunction, researchers set out to analyze the effect of angiotensin-converting enzyme (ACE) inhibitors, angiotensin-receptor blockers (ARBs), beta blockers, and aldosterone antagonists in adults with this condition.

To be counted in this systematic review, inclusion criteria included age ≥ 18 years, presence of systemic RVs, and at least 3-month treatment with an ACE inhibitor, ARB, beta blocker, or aldosterone antagonist. Outcomes data were RV end-diastolic and end-systolic dimensions, RV ejection fraction, functional class, and exercise capacity. Databases used to identify possible studies were EMBASE, PubMed, and Cochrane. Six studies, comprising 187 total patients, ultimately met the inclusion criteria. Beta-blocker intervention was excluded because it was unable to be analyzed due to a small number of patients and the diversity of outcomes reported.

The researchers found that after at least 3 months of treatment with ACE inhibitors, ARBs, or aldosterone antagonists, there was no statistically significant change in mean ejection fraction, ventricular dimensions, or peak ventilatory equivalent of oxygen. However, across all six studies analyzed, methodologic quality was considered low, mostly because of lack of a randomized and controlled design, small sample size, and incomplete follow-up, noted the researchers.

Investigators in Circulation concluded that pooled results across the limited number of available studies did not provide conclusive evidence with regard to a beneficial effect of medical therapy in adults with systemic RV dysfunction. Randomized controlled trials or comparative-effectiveness studies that are sufficiently powered to demonstrate effect are needed to elucidate the efficacy of ACE inhibitors, ARBs, beta blockers, and aldosterone antagonists in patients with systemic RVs, recommend the study investigators.

This systematic review was conducted in support of the recently published “2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease.”