META-ANALYSIS ASSESSING THE EFFECTS OF ALLOPURINOL ON LEFT VENTRICULAR MASS AND OTHER INDICES OF LEFT VENTRICULAR REMODELING AS EVALUATED BY CARDIAC MAGNETIC RESONANCE IMAGING

Abstract

Objective: Hyperuricemia is a relatively common morbidity, featuring a close relationship with cardiovascular disease, hypertension, heart failure and chronic kidney disease, while it is also related to the development of type 2 diabetes mellitus. Allopurinol remains the mainstay of treatment. We sought to determine whether allopurinol affects left ventricular (LV) mass and other measures of LV remodeling, as assessed by cardiac magnetic resonance imaging (cMRI). Design and method: We performed a systematic search in two major electronic databases, PubMed and Cochrane Central Register of Controlled Trials (CENTRAL), for eligible randomized controlled trials (RCTs), from their inception to September 2020, along with grey literature sources. Results: Our search yielded 84 results in total. Finally, 4 records were included in our quantitative synthesis. Our analysis in a total of 225 patients showed that allopurinol treatment produced a non-significant decrease in LV mass by 1.42 g (MD = -1.42, 95% CI -6.34 to 3.50, I2 = 90%), and a non-significant decrease in LV mass index by 1.47 g/m2 (MD = -1.47, 95% CI -3.91 to 0.96, I2 = 91%). In addition, allopurinol did not decrease significantly neither LV end systolic volume (MD = -0.45 mL, 95% CI -5.53 to 4.64, I2 = 56%) nor LV end diastolic volume (MD = -2.98 mL, 95% CI –9.39 to 3.43, I2 = 35%). Finally, allopurinol did not affect significantly LV stroke volume (MD = 2.06 mL, 95% CI –2.02 to 6.14, I2 = 0%). We consider as major limitations of the present meta-analysis the small number of included RCTs and enrolled participants, which did not permit us to perform subgroup analyses in order to investigate the sources of heterogeneity. Conclusions: Conclusion: Allopurinol does not exert a significant effect on LV mass and other indices of LV remodeling, as quantified by cMRI, in a broad population with significant cardiovascular co-morbidities.