Antagonists of mineralocorticoid receptors in the treatment of patients with post-infarced heart failure: the role of eplerenon

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Aim. To present modern view on the role of mineralocorticoid receptor antagonists (MRA), eplerenone in particular, in treatment of patients with post-infarction cardiac failure, and to analyze its effectiveness and safety. Materials and methods. Data fr om scientific sources published in Russia and abroad in 1984-2018 years were analyzed. Conclusion. Acute myocardial infarction with congestive cardiac failure (CCF) development is associated with sympathoadrenal system and renin-angiotensin-aldosterone cascade hyperactivation that results in pathologic myocardium remodeling following fibrosis. Within the concept of quality of life improvement and lifetime increase in patients after myocardial infarction it is important to prescribe MRA, eplerenone in particular, besides renin-angiotensin-aldosterone system inhibitors and b-adrenoblockers (b-AB). Accumulated data on MRA effectiveness in patients with CCF including patients after myocardial infarction is the basis for inclusion of these medications in National guidelines on CSF diagnostics and treatment of Russian Society of Cardiology and Russian Scientific Medical Society of Therapists. According to these guidelines medications of this group are recommended (level IA) to the use (combined with angiotensin-converting enzyme inhibitors - ACE inhibitors and b-AB) in all patients with medium severe and severe CHF who have decreased contractile function of left ventricle in order to decrease mortality risk and readmission frequency and to improve symptoms. A similar point of view is presented in European Society of Cardiology guidelines wh ere MRA also have IA level of evidence to the use as a first line medication (together with ACE inhibitors and b-AB for CHF treatment). The presented clinical case supported by the evidence of previously conducted studies demonstrates the leading role of eplerenon in therapy that results in prognosis improvement in patients with CHF after myocardial infarction who have low left ventricular ejection fraction.

About the authors

Vasily V. Kashtalap

Research Institute for Complex Issues of Cardiovascular Diseases; Kemerovo State Medical University of the Ministry of Health of the Russian Federation

D. Sci (Med.), Associate Professor, Head of Laboratory of pathophysiology of multivessel coronary artery disease and polyvascular disease, Associate Professor of the Department of Cardiology and Cardiovascular Surgery 6, Sosnovyi bvd, Kemerovo, 650002, Russian Federation

Darya Yu. Sedykh

Research Institute for Complex Issues of Cardiovascular Diseases; L.S.Barbarash Kemerovo Regional Clinical Cardiology Dispensary

Research Associate of Laboratory of pathophysiology of multivessel coronary artery disease and polyvascular disease 6, Sosnovyi bvd, Kemerovo, 650002, Russian Federation

Olga L. Barbarash

Research Institute for Complex Issues of Cardiovascular Diseases; Kemerovo State Medical University of the Ministry of Health of the Russian Federation

Corresponding Member of the Russian Academy of Sciences, D. Sci (Med.), Prof., Head of the Department of Cardiology and Cardiovascular Surgery, Director 6, Sosnovyi bvd, Kemerovo, 650002, Russian Federation

References

  1. Сумин А.Н. Оптимальная медикаментозная терапия хронической сердечной недостаточности: роль антагонистов минералокортикоидных рецепторов. РМЖ. 2018; 11 (1): 71-5. [
  2. Зыков М.В., Зыкова Д.С., Каштлап В.В. и др. Значимость мультифокального атеросклероза для модификации шкалы риска отдаленной смертности GRACE у больных острым коронарным синдромом с подъемом сегмента ST. Атеросклероз. 2012; 8 (1): 14-20.
  3. Косягина Д.Д., Завырылина П.Н., Седых Д.Ю. и др. Факторы, ассоциированные с поздним обращением за медицинской помощью при инфаркте миокарда. Комплексные проблемы сердечно-сосудистых заболеваний. 2017; 3: 104-12.
  4. Komajda M, Cowie M.R, Tavazzi L et al. QUALIFY Investigators. Physicians’ guideline adherence is associated with better prognosis in outpatients with heart failure with reduced ejection fraction: the QUALIFY international registry. Eur J Heart Fail 2017; 19 (11): 1414-23. doi: 10.1002/ejhf.887
  5. Гиляревский С.Р., Голшмид М.В., Кузьмина И.М. Роль антагонистов рецепторов альдостерона в профилактике и лечении сердечно-сосудистых и почечных заболеваний: реальность и перспективы. Рус. мед. журн. 2014; 23: 1689-98.
  6. Nagarajan V, Chamsi-Pasha M, Tang W.H. The role of aldosterone receptor antagonists in the management of heart failure: an update. Cleve Clin J Med 2012; 79: 631-39.
  7. Edelmann F, Schmidt A.G, Gelbrich G et al. Rationale and design of the “aldosterone receptor blockade in diastolic heart failure” trial: a double-blind, randomized, placebo-controlled, parallel group study to determine the effects of spironolactone on exercise capacity and diastolic function in patients with symptomatic diastolic heart failure (Aldo-DHF). Eur J Heart Fail 2010; 12: 874-82.
  8. MacFadyen R.J, Lee A.F, Morton J.J et al. How often are angiotensin II and aldosterone concentrations raised during chronic ACE inhibitor treatment in cardiac failure? Heart 1999; 82: 57-61.
  9. Национальные рекомендации ОССН, РКО и РНМОТ. Сердечная недостаточность: хроническая и острая декомпенсированная. Диагностика, профилактика и лечение (5-й пересмотр). М., 2018. doi: 10.18087/cardio. 2475
  10. McKelvie R.S, Yusuf S, Pericak D et al. Comparison of candesartan, enalapril, and their combination in congestive heart failure: randomized evaluation of strategies for left ventricular dysfunction (RESOLVD) pilot study. The RESOLVD Pilot Study Investigators. Circulation 1999; 100: 1056-64.
  11. Vizzardi E, Nodari S, Caretta G et al. Effects of spironolactone on long-term mortality and morbidity in patients with heart failure and mild or no symptoms. Am J Med Sci 2014; 347 (4): 271-6.
  12. Pitt B, Zannad F, Remme W.J et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators. N Engl J Med 1999; 341: 709-17.
  13. Jeunemaitre X, Chatellier G., Kreft-Jais C et al. Efficacy and tolerance of spironolactone in essential hypertension. Am J Cardiol 1987; 60: 820-5.
  14. Sabbadin C, Calò L.A, Armanini D. The story of spironolactones from 1957 to now: from sodium balance to inflammation. G Ital Nefrol 2016; 33 (Suppl. 66): 33.
  15. De Gasparo M, Joss U, Ramjoué H.P et al. Three new epoxy-spirolactone derivatives: characterization in vivo and in vitro. J Pharmacol Exp Ther 1987; 240: 650-6.
  16. Pitt B, Remme W, Zannad F et al. Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study Investigators. Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med 2003; 348: 1309-21.
  17. Pitt B, White H, Nicolau J et al., EPHESUS Investigators. Eplerenone reduces mortality 30 days after randomization following acute myocardial infarction in patients with left ventricular systolic dysfunction and heart failure. J Am Coll Cardiol 2005; 46: 425-31.
  18. Подзолков В.И., Драгомирецкая Н.А. Антагонисты альдостерона. Современные представления о механизмах действия и эффектах спиронолактона. Рацион. фармакотерапия в кардиологии. 2017; 13 (2): 263-9. DOI: http://dx.doi.org/10.20996/1819- 6446-2017-13-2-263-269
  19. Iqbal J, Fay R, Adlam D et al. Effect of eplerenone in percutaneous coronary intervention-treated post-myocardial infarction patients with left ventricular systolic dysfunction: a subanalysis of the EPHESUS trial. Eur J Heart Fail 2014; 16: 685-91.
  20. Carillo S, Zhang Y, Fay R et al. Heart failure with systolic dysfunction complicating acute myocardial infarction - differential outcomes but similar eplerenone efficacy by ST-segment or non-ST-segment elevation: a post hoc substudy of the EPHESUS trial. Arch Cardiovasc Dis 2014; 107: 149-57.
  21. Tsutamoto T, Wada A, Maeda K et al. Spironolactone inhibits the transcardiac extraction of aldosterone in patients with congestive heart failure. J Am Coll Cardiol 2000; 36: 838-44.
  22. Hayashi M, Tsutamoto T, Wada A et al. Immediate administration of mineralocorticoid receptor antagonist spironolactone prevents postinfarct left ventricular remodeling associated with suppression of a marker of myocardial collagen synthesis in patients with first anterior acute myocardial infarction. Circulation 2003; 107: 2559-65.
  23. Bender S.B, DeMarco V.G, Padilla J et al. Mineralocorticoid receptor antagonism treats obesity-associated cardiac diastolic dysfunction. Hypertension 2015; 65 (5): 1082-8.
  24. Zannad F, McMurray J.J, Krum H et al., EMPHASIS-HF Study Group. Eplerenone in patients with systolic heart failure and mild symptoms. N Engl J Med 2011; 364: 11-21.
  25. Ademi Z, Pasupathi K, Krum H, Liew D. Cost effectiveness of eplerenone in patients with chronic heart failure. Am J Cardiovasc Drugs 2014; 14: 209-16.
  26. Shah K.B, Rao K, Sawyer R, Gottlieb S.S. The adequacy of laboratory monitoring in patients treated with spironolactone for congestive heart failure. J Am Coll Cardiol 2005; 46: 845-9.
  27. Juurlink D.N, Mamdani M.M, Lee D.S et al. Rates of hyperkalemia after publication of the Randomized Aldactone Evaluation Study. N Engl J Med 2004; 351: 543-51.
  28. ESC Guidelines: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology. Eur Heart J 2016; 37: 2129-200. doi: 10.1093/eurheartj/ehw128
  29. Карпов Ю.А. Эплеренон: улучшение прогноза у больных с хронической сердечной недостаточностью ишемической этиологии. Атмосфера. Новости кардиологии. 2014; 2: 28-36.

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