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Comparison of eplerenone and spyronolacton effects in prevention of left ventricular remodeling and development of heart failure in patients after STEMI

Session Poster Session 4

Speaker Iulia Rodionova

Event : Heart Failure 2019

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Coronary Artery Disease: Treatment, Revascularization
  • Session type : Poster Session

Authors : I Rodionova (Kharkiv,UA), YV Hilova (Kharkiv,UA), MP Kopytsya (Kharkiv,UA), I N Kutya (Kharkiv,UA), OV Petyunina (Kharkiv,UA)

Authors:
I Rodionova1 , YV Hilova1 , MP Kopytsya1 , I N Kutya1 , OV Petyunina1 , 1L.T.Malaya Institute of Therapy - Kharkiv - Ukraine ,

Citation:

Background: The development of post-infarction remodelling of the left ventricle in patients with ST segment elevation myocardial infarction (STEMI) is an urgent problem of cardiology, as its development worsens the prognosis. Soluble ST2 (sST2) is a marker of fibrosis, which plays a significant role in the development of myocardial remodelling. Antagonists of mineralocorticoid receptors affect the development of myocardial fibrosis and improve the left ventricle remodelling (LV).

Purpose: Compare eplerenone and spironolactone efficacy in preventing LV remodelling and development of heart failure in patients after STEMI with elevated sST2

Methods: 103 STEMI patients were screened (72.8% male and 27.2% female), mean age was 61.85±12.23 years. The levels of sST2 were determined during the first day of hospitalization. A group of 56 patients with sST2 =35 ng / ml and stored LV. The examined patients were divided into two groups: the first received eplerenon, and the second one - spironolactone

Results: After 6 months of observation, the groups with remodeling of LV and without it were compared. The blood serum sST2 in the remodeling group was 50.35 [27.17-103.20] ng / ml and 28.02 [21.75-34.70] ng / ml in the group without LV remodelling (p <0.015 ) Multivariate logistic analysis revealed a significant effect of sST2 on the development of LV remodelling after 6 months of observation (ß = -0.079; OR: 0.924; 95% CI 0.8624 - 0.9902; p = 0.025). To study the significance of sST2 in predicting the onset of LV remodelling, ROC analysis was performed. The level of more than 44.5 ng / ml allows to predict the development of LV remodelling, AUC = 0.707, (95% CI 0.533-0.882; P = 0.0198), with a sensitivity of 85.7% and a specificity of 57.1%.

Eplerenon significantly lowered sST2: from 116.00 [36.91-193.41] to 44.24 [29.52-83.96] (p = 0.039), in the spironolactone group, no significant changes in sST2 occurred. In the group of patients receiving spironolactone there was an increase of end-diastolic volume (EDV) from 117,00 ± 27,64 ml to 143,06 ± 47,12 ml (p = 0,014), but eplerenone prevented EDV LV incresaing. The studied drugs did not effect on ejection fraction (EF) LV. In addition, in the eplerenone group, the distance of the 6-minute walk test (6MWT) augmented from 411.3m to 524.4m (p = 0.048), there were no 6MWT changes in the spironolactone group.

Conclusions:The increased sST2 serum level is a prediction of LV remodelling. The use of eplerenone in patients after STEMI with an elevated sST2 level has the advantage of spironolactone using. Eplerenone significantly decrease sST2 level, prevents the development of abnormal left ventricular remodelling and increases the tolerance to physical activity after 6 months of observation.

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