Chronic heart failure as a myocardial infarction complication: therapy features
M.D. Smirnova, F.T. Ageev
National Medical Research Center of Cardiology, Moscow
The review article examines the role of mineralocorticoid receptor antagonists (MCRA) in the heart failure (HF) treatment in patients after acute myocardial infarction (AMI). The pathogenetic basis of the MCRA effects on cardiac remodelling after AMI is considered. The pharmacological characteristics of this medicinal product class — spironolactone and eplerenone — are also described. The main study results proving the eplerenone protective role in patients after AMI with HF of varying severity (EPHESUS, EMPHASIS-HF, ALBATROSS, REMINDER) are highlighted. The article presents an analysis of the eplerenone effectiveness depending on the timing of its appointment, as well as the drug safety in comparison with spironolactone. To sum up, it is advisable to use these medicinal products in routine therapy in the acute, subacute and long-term periods of AMI with an increase in the ST-segment of MCRA prescription fo r patients with left ventricular ejection fraction ≤40%, HF or diabetes mellitus, who are already receiving angiotensin-converting enzyme and beta-blockers in the absence of renal failure or hyperpotassemia. Moreover, preference should be given to eplerenone, as a drug that has the most convincing evidence base and has a favorable tolerance profile. The effective generic eplerenone introduction into medical practice makes it possible to expand its use in real clinical practice
Keywords: myocardial infarction, complications, heart failure, cardiac remodelling, eplerenone, Ipleron.
For citation: Smirnova M.D., Ageev F.T. Chronic heart failure as a myocardial infarction complication: therapy features. RMJ. Medical Review. 2019;10(I):40–44.
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12. 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;12:874–882.
13. Swedberg K., Eneroth P., Kjekshus J., Wilhelmsen L. Hormonesregulating cardiovascular function in patients with severe congestive heart failure and their relation to mortality. CONSENSUS Trial Study Group. Circulation. 1990;82:1730–1736.
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15. Осипова О.А., Петрова Г.Д., Шеховцова Л.В. и др. Основные патогенетические механизмы развития хронической сердечной недостаточности на фоне ишемической болезни сердца. Научные ведомости Белгородского гос. ун-та. Серия: Медицина. Фармация. 2015;29(4):11–15. [Osipova O.A., Petrova G.D., Shekhovtsova L.V. and others. The main pathogenetic mechanisms of the development of chronic heart failure on the background of coronary heart disease. Scientific reports of Belgorod State University. Series: Medicine. Pharmacy. 2015;29(4):11–15 (in Russ.)].
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17. Weber K.T., Brilla C.G. Pathological hypertrophy and cardiac interstitium: fibrosis and renin-angiotensin-aldosterone system. Circulation. 1991;83:1849–1865.
18. Mano A., Tatsumi T., Shiraishi J. et al. Aldosterone directly induces myocyte apoptosis through calcineurin-dependent pathways. Circulation. 2004;110:317–323.
19. Карпов Ю.А. Эплеренон: улучшение прогноза у больных с хронической сердечной недостаточностью ишемической этиологии. Атмосфера. Новости кардиологии. 2014;2:28–36. [Karpov Yu.A. Eplerenone: improved prognosis in patients with chronic heart failure of ischemic etiology. Atmosphere. Cardiology News. 2014;2:28–36 (in Russ.)].
20. MacFadyen R.J., Lee A.F., Morton J.J. et al. How often are angiotensin II and ldosterone concentrations raised during chronic ACE inhibitor treatment in cardiac failure? Heart. 1999;82:57–61.
21. 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 nvestigators. Circulation. 1999;100:1056–1064.
22. Tang W.H., Vagelos R.H., Yee Y.G. et al. Neurohormonal and clinical responses to high- versus low-dose enalapril therapy in chronic heart failure. J Am Coll Cardiol. 2002;39:70–78.
23. Weber K.T. Aldosterone in congestive heart failure. N Engl J Med. 2001;345:1689–1697.
24. Jessup M., Abraham W.T., Casey D.E. et al. Focused update: ACCF/AHA guidelines for the diagnosis and management of heart failure in adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation. 2009;119:1977–2016.
25. Albert N.M., Yancy C.W., Liang L. et al. Use of aldosterone antagonists in heart failure. JAMA. 2009;21:1658–1665.
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