Angiotensin converting enzyme inhibitors versus digoxin for the treatment of congestive heart failure

Evaluating the impact of Sacubitril/valsartan on diastolic function in patients with heart failure: A systematic review and meta-analysis

BACKGROUND

Heart failure is a common and severe condition, often complicated by diastolic dysfunction. Current standard therapies such as ACEIs and ARBs have limited efficacy in managing diastolic function. Sacubitril/Valsartan, an emerging therapy, warrants rigorous investigation to elucidate its impact on diastolic function in heart failure patients.

METHODS

This systematic review and meta-analysis were conducted adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and utilized the PICO schema. Searches were performed on 4 databases-PubMed, Embase, Web of Science, and Cochrane Library-without temporal restrictions. Inclusion and exclusion criteria were strictly defined, and quality assessments were conducted using the Cochrane Collaboration Risk of Bias tool. Both fixed-effects and random-effects models were used for statistical analysis, depending on inter-study heterogeneity assessed by I2 statistics and Chi-square tests.

RESULTS

Out of 1129 identified publications, 8 studies met the criteria and were included in the meta-analysis. These studies consisted of both randomized controlled trials and cohort studies and featured diverse global populations. Significant reductions were found in the echocardiographic parameter E/e' ratio and LAVi upon treatment with Sacubitril/Valsartan compared to standard therapies, with mean differences of -1.38 and -4.62, respectively, both with P values < .01.

CONCLUSIONS

This meta-analysis demonstrates that Sacubitril/Valsartan significantly improves diastolic function parameters in heart failure patients compared to standard treatments. These findings underscore the potential benefits of Sacubitril/Valsartan in the management of heart failure, particularly for patients with diastolic dysfunction.

ASSESSMENT OF EFFECTIVE BLOOD CONCENTRATION READINGS FROM CLINICAL DATA ON PATIENTS WITH HEART FAILURE DISEASES AFTER DIGOXIN INTAKE: A PROJECTION BASED ON THE INVERSE PROBLEM ALGORITHM

In this study, a projection of effective blood concentration (EBC) readings of digoxin is made using the inverse problem algorithm based on clinical data for patients with heart failure diseases. Seven factors, including body surface area (BSA), blood urine nitrogen (BUN), creatinine, sodium (Na), potassium (K), magnesium (Mg) ion readings, and mean arterial pressure (MAP) were compiled with nonlinear regression fit to develop a projection function having 29 terms obtained from an inverse problem algorithm via the default function run in STATISTICA. Accordingly, data collected from the clinical 168 heart failure patients were normalized to be included in same domain range ([Formula: see text]1 to +1), and then calculated by the specific algorithm to optimize the numerical solution to evaluate EBC readings of digoxin. The evaluated first-order regression fit owned an optimal loss function ([Formula: see text]) coupled with correlation coefficient [Formula: see text] = 0.892 and variance of 89.20%. Furthermore, 45 patients having similar clinical syndromes were also adopted to verify the projection and implied with high agreement. The BUN factor dominated the projection and defined as the most significant coefficient in the analysis, and K ion, MAP, BSA, and Mg ion factors exhibited minor contributions to the projection. The repeated trials to lower number of factors from seven to a smaller number (namely 6, 5, 4, 3, 2, and 1) for simplifying method but resulting with unaccepted outcomes, with high loss function values and low linearity. However, the algorithm held its accuracy to handle the verified data that were out of the original bounds. The proposed algorithm demonstrated a useful analysis to handle the drug administration in pharmaceutical field.

Multicenter, randomized, placebo-controlled, double-blind study of the safety and efficacy of oral delapril in patients with congestive heart failure

A total of 101 patients (67 delapril, 34 placebo) with congestive heart failure, New York Heart Association (NYHA) classes II and III, entered a multicenter, randomized (2:1), double-blind, placebo-controlled study to determine the minimum effective and maximum tolerated doses of delapril. Patients received placebo or increasing doses of delapril. After a 2-week run-in period on placebo, patients were randomly assigned to delapril or placebo. The dose of delapril was 7.5 mg twice daily for 2 weeks, 15 mg twice daily for another 2 weeks, followed by 30 mg twice daily for 4 weeks. The dose was increased only if the patient did not present any symptoms of orthostatic hypotension. If such symptoms developed, the code was broken and an open treatment was continued on the minimum effective dose (delapril group). Patients with symptoms of orthostatic hypotension in the placebo group were withdrawn. At the end of the 8-week treatment, 36 (54.5%) patients in the delapril group completed the study on 30 mg twice daily, 12 (18.2%) on 15 mg twice daily, and 18 (27.3%) on 7.5 mg twice daily. Seven patients on placebo were withdrawn because of insufficient therapeutic response; one patient on delapril was lost to follow-up. There was a significant improvement (p < 0.01) in bicycle ergometric performance involving an increase in the exercise duration and the maximum workload tolerated in those patients completing the study on delapril 30 mg twice daily and those finishing on 15 mg twice daily.(ABSTRACT TRUNCATED AT 250 WORDS)

Plasma exudation in conscious dogs with experimental heart failure

The purpose of this study was to determine the effects of bradykinin (BK), substance P (SP) and histamine on plasma exudation in the skin of conscious dogs with and without pacing-induced heart failure. We also determined the role tissue angiotensin I-converting enzyme (ACE) and neutral endopeptidase (NEP) play in modulating these responses. We found that intradermal injection of BK, SP and histamine induced a significant, concentration-dependent Evans blue exudation in normal dogs (p < 0.05). Bradykinin-induced responses were significantly potentiated by captopril (p < 0.05). In contrast, phosphoramidon potentiated BK-induced responses only at low concentrations of BK. Both captopril and phosphoramidon had no significant effects on SP- and histamine-induced Evans blue exudation. BK- and SP-induced responses were significantly attenuated, whereas histamine-induced Evans blue exudation was significantly potentiated in dogs with heart failure. We conclude that heart failure is associated with attenuation of BK- and SP-, but not histamine-induced plasma exudation in the peripheral microcirculation and that these responses are not modulated by tissue ACE and NEP.