WASHINGTON, DC—Study authors from The Wright Center for Graduate Medical Education, Scranton, PA, presented at the ACC.17 Scientific Session that sildenafil did not lead to significant improvement in hemodynamic parameters in heart failure (HF) patients with preserved ejection fraction. 

For patients with heart failure with preserved ejection fraction (HFpEF), complications such as pulmonary artery hypertension and right-sided heart failure can worsen the prognosis. Sildenafil, a phosphodiesterase-5 inhibitor (PDE5I), is an approved treatment for pulmonary artery hypertension. Lead author Anurag Bajaj stated, “The literature evaluating the effect of sildenafil in HFpEF is scant and lacks precision in view of the small patient size.” 

Bajaj and researchers conducted a meta-analysis to assess the efficacy of sildenafil on hemodynamic parameters in patients with HFpEF. They identified relevant studies through a systematic search of various databases. Studies that compared sildenafil vs. placebo with a minimum treatment period of ≥9 weeks in patients with HFpEF were included.

“The primary outcome measure was pulmonary artery systolic pressure (PASP) and secondary outcomes were cardiac index (CI), right atrial pressure (RAP), peak oxygen consumption (pVo2), and serious adverse events,” Bajaj said. Four randomized controlled studies including 379 patients were identified for the meta-analysis. 

No significant differences in PASP (WMD –5.22, 95% CI: –16.26, 5.81), CI (WMD 1.79, 95% CI: –0.91, 4.50), RAP (WMD –2.45, 95% CI: –7.11, 2.20), and pVo2 (odds ratio [OR] 0.20, 95% CI: 0.09, 0.31) were seen. During the total follow-up period, serious adverse events were reported in 12.8% of patients. Further, there was no significant difference in the rate of serious adverse events between the two groups (OR 1.51, 95% CI: 0.77, 2.96). 

Overall, sildenafil did not demonstrate significant improvement in hemodynamic parameters in patients with HFpEF. “More randomized controlled trials are needed to define the role of sildenafil in HFpEF,” Bajaj concluded.