The impact of new tetralogy drugs on ventricular remodeling in heart failure patients: a systematic review and network meta-analysis
Abstract
BACKGROUND: Heart failure, particularly heart failure with reduced ejection fraction (HFrEF), represents a major global health challenge due to its high prevalence, rapid progression, and substantial mortality rates. While the “New Tetralogy” drugs (angiotensin receptor-neprilysin inhibitors, sodium-glucose cotransporter 2 inhibitors, beta-blockers, and mineralocorticoid receptor antagonists) have significantly advanced HFrEF management, their comparative effects on ventricular remodeling remain unclear. This network meta-analysis systematically evaluates these therapeutic agents to inform optimal clinical decision-making. METHODS: We conducted a comprehensive search of PubMed, Cochrane Library, Embase, and Web of Science for randomized controlled trials (RCTs) evaluating ventricular remodeling parameters in HFrEF patients. Twenty-two RCTs involving 16,425 participants were included. Data were analyzed using Stata 14.2 and RevMan 5.3, with outcomes expressed as mean differences (MD) and 95% confidence intervals (CI). RESULTS: Our study showed markedly different therapeutic characteristics: sodium-glucose cotransporter 2 inhibitors significantly reduced left ventricular mass index (MD = -6.57, 95% CI: -11.98 to -1.16), while beta-blockers demonstrated superior improvement in left ventricular ejection fraction compared to mineralocorticoid receptor antagonists (MD = 3.54, 95% CI: 0.60 to 6.48) through indirect comparison. Mineralocorticoid receptor antagonists showed greater…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 16,425 participants or records.
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