Aldosterone Receptor Blockade in Heart Failure with Preserved Ejection Fraction.

Published on Aug 18, 2018in Heart Failure Clinics3.179
路 DOI :10.1016/J.HFC.2018.06.002
Ajith Nair15
Estimated H-index: 15
(BCM: Baylor College of Medicine),
Anita Deswal59
Estimated H-index: 59
(Michael E. DeBakey Veterans Affairs Medical Center in Houston)
Sources
Abstract
: More than 50% of patients with clinical heart failure have a preserved ejection fraction. Despite mortality that is similar to or slightly lower than heart failure with reduced ejection fraction, trials to date have not shown a therapy that imparts a mortality benefit in heart failure with preserved ejection fraction (HFpEF). HFpEF represents a heterogeneous disorder with a complex pathophysiologic basis, and this may contribute to the negative results in clinical trials. Geographic variations in both patient selection and adherence to study medications confound the interpretation of the trial results. Mineralocorticoid receptor antagonists may be useful in selected patients.
馃摉 Papers frequently viewed together
References54
Newest
#1Gavin A. LewisH-Index: 4
#2Erik B. Schelbert (University of Pittsburgh)H-Index: 31
Last. Christopher A. MillerH-Index: 20
view all 7 authors...
Abstract Heart failure with preserved ejection fraction (HFpEF) involves multiple pathophysiological mechanisms, which result in the heterogeneous phenotypes that are evident clinically, and which have potentially confounded previous HFpEF trials. A greater understanding of the in聽vivo human processes involved, and in particular, which are the causes and which are the downstream effects, may allow the syndrome of HFpEF to be distilled into distinct diagnoses based on the underlying biology. From...
Source
Glenn N. Levine, MD, FACC, FAHA, Chair Patrick T. O鈥橤ara, MD, FACC, FAHA, Chair-Elect Jonathan L. Halperin, MD, FACC, FAHA, Immediate Past Chair [鈥♀[1] Sana M. Al-Khatib, MD, MHS, FACC, FAHA Kim K. Birtcher, PharmD, MS, AACC Biykem Bozkurt, MD, PhD, FACC, FAHA Ralph G. Brindis, MD,
Source
In a subgroup of TOPCAT participants assigned to spironolactone, the spironolactone metabolite canrenone was measured to assess adherence. Canrenone levels were undetectable in 30% of participants from Russia, as compared with only 3% from the United States and Canada.
Source
#10Laura Ross Loehr (UNC: University of North Carolina at Chapel Hill)H-Index: 13
Abstract Background Levels of B-type natriuretic peptide (BNP), a prognostic marker in patients with heart failure (HF), are lower among HF patients with obesity or preserved Left Ventricular Ejection Fraction (LVEF). We examined the distribution and prognostic value of BNP across BMI categories in acute decompensated heart failure (ADHF) patients with preserved vs. reduced LVEF. Methods We analyzed data from the Atherosclerosis Risk in Communities (ARIC) HF surveillance study which sampled and ...
Source
Abstract Objectives The aims of this study were to explore the relationship of baseline levels of natriuretic peptides (NPs) with outcomes and to test for an interaction between baseline levels of NPs and the effects spironolactone. Background Plasma NPs are considered to be helpful in the diagnosis of heart failure (HF) with preserved ejection fraction (HFpEF), and elevated levels are associated with adverse outcomes. Levels of NPs higher than certain cutoffs are often used as inclusion criteri...
Source
#1Emelia J. BenjaminH-Index: 149
#2Michael J. BlahaH-Index: 85
Last. Cathleen GillespieH-Index: 51
view all 45 authors...
Source
#1Nicolas M. Berbenetz (UWO: University of Western Ontario)H-Index: 5
#2Marko Mrkobrada (UWO: University of Western Ontario)H-Index: 23
Background Mineralocorticoid receptor antagonists (MRAs) have been associated with improved patient outcomes in patients with heart failure with reduced ejection fraction (HFrEF) but not preserved ejection fraction (HFpEF). We conducted a systematic review and meta-analysis of selective and nonselective MRAs in HFrEF and HFpEF.
Source
#1Wojciech Kosmala (UTAS: University of Tasmania)H-Index: 23
#2Aleksandra Rojek (Wroc艂aw Medical University)H-Index: 7
Last. Thomas H. Marwick (UTAS: University of Tasmania)H-Index: 140
view all 6 authors...
Abstract Background Impaired functional capacity is a hallmark of patients with heart failure with preserved ejection fraction (HFpEF). Despite the association of HFpEF with reduced myocardial compliance attributed to fibrosis, spironolactone has not been shown to alter outcomes鈥攑erhaps reflecting the heterogeneity of underlying pathological mechanisms. Objectives The authors sought to identify improvement in exercise capacity with spironolactone in the subset of patients with HFpEF with exercis...
Source
#1Marc A. Pfeffer (Brigham and Women's Hospital)H-Index: 187
#2Eugene Braunwald (Brigham and Women's Hospital)H-Index: 269
Source
#1Ambarish Pandey (UTSW: University of Texas Southwestern Medical Center)H-Index: 45
#2Sushil Kumar GargH-Index: 25
Last. Dharam J. KumbhaniH-Index: 44
view all 12 authors...
Background There has been an increasing interest in use of mineralocorticoid receptor antagonists (MRAs) in patients with heart failure with preserved ejection fraction (HFPEF). However, a comprehensive evaluation of MRA effects on left ventricular (LV) structure and function in these patients is lacking. In this meta鈥恆nalysis, we evaluated the effects of MRAs on LV structure and function among patients with diastolic dysfunction or HFPEF. Methods & Results Randomized, controlled clinical trials...
Source
Cited By6
Newest
Source
#1Koert de Waal (University of Newcastle)H-Index: 17
#2Rahul Prasad (Boston Children's Hospital)
Last. Martin Kluckow (RNSH: Royal North Shore Hospital)H-Index: 42
view all 3 authors...
Abstract The published literature on patent ductus arteriosus (PDA) management is challenging to interpret due to poorly designed trials with high rates of open label treatments, homogenisation of patients with varying physiological subtypes, poor treatment efficacy, and spontaneous closure in more mature infants. The perceived lack of clinical benefit has led to a drift away from medical and surgical treatment of all infants with a PDA. This therapeutic nihilism as a default response to PDA man...
Source
#1Anju Bhardwaj (University of Texas at Austin)
#2Vishal Parikh (UR: University of Rochester)H-Index: 2
Last. Ajith NairH-Index: 15
view all 3 authors...
Abstract Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome, which accounts for about 50% of patients with heart failure (HF). The morbidity and mortality associated with HFpEF is similar to HFrEF. Clinical trials to date have failed to show a benefit of medical therapy for HFpEF, which may due to lack of uniform phenotypes and heterogeneous population. In addition, medical therapy proven for HFrEF may not address the pathophysiologic basis for HFpEF. Left atrial remod...
Source
#1Domenico D'AmarioH-Index: 27
#2Stefano Migliaro (Agostino Gemelli University Polyclinic)H-Index: 1
Last. Filippo Crea (UCSC: Catholic University of the Sacred Heart)H-Index: 106
view all 11 authors...
Heart failure with preserved ejection fraction (HFpEF) is an increasingly studied entity accounting for 50% of all diagnosed heart failure and that has claimed its own dignity being markedly different from heart failure with reduced EF in terms of etiology and natural history (Graziani et al., 2018). Recently, a growing body of evidence points the finger toward microvascular dysfunction as the major determinant of the pathological cascade that justifies clinical manifestations (Crea et al., 2017...
Source
#1Gabriella Francesca Mattina (McMaster University)H-Index: 4
#2Ryan J. Van Lieshout (McMaster University)H-Index: 28
Last. Meir Steiner (St. Joseph's Healthcare Hamilton)H-Index: 80
view all 3 authors...
Women are at increased risk for developing depression and cardiovascular disease (CVD) across the lifespan and their comorbidity is associated with adverse outcomes that contribute significantly to rates of morbidity and mortality in women worldwide. Immune-system activity has been implicated in the etiology of both depression and CVD, but it is unclear how inflammation contributes to sex differences in this comorbidity. This narrative review provides an updated synthesis of research examining t...
Source
#1Constantine E Kosmas (Montefiore Medical Center)H-Index: 8
#2Delia SilverioH-Index: 6
Last. Eliscer Guzman (Montefiore Medical Center)H-Index: 7
view all 5 authors...
Heart failure (HF) is the leading cause of morbidity and mortality globally. Heart failure with preserved ejection fraction (HFpEF) is currently responsible for about half of the patients affected with HF and is associated with impaired functional capacity, as well as significant morbidity due to frequent hospitalizations. Unfortunately, despite its poor prognosis, the management of HFpEF is very controversial and no therapy has been so far shown to reduce mortality in HFpEF. Spironolactone anta...
Source
This website uses cookies.
We use cookies to improve your online experience. By continuing to use our website we assume you agree to the placement of these cookies.
To learn more, you can find in our Privacy Policy.