In line with the ESC mission, newly presented content is made available to all for a limited time (4 months for ESC Congress, 3 months for other events). ESC Professional Members, Association Members (Ivory & above) benefit from year-round access to all the resources from their respective Association, and to all content from previous years. Fellows of the ESC (FESC), and Professionals in training or under 40 years old, who subscribed to a Young Combined Membership package benefit from access to all ESC 365 content from all events, all editions, all year long. Find out more about ESC Memberships here.
Comparison of eplerenone and spyronolacton effects in prevention of left ventricular remodeling and development of heart failure in patients after STEMI
The ESC does not have the copyright for the slides and video of this presentation
I N Kutya1
1L.T.Malaya Institute of Therapy - Kharkiv - Ukraine
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.
ESC 365 is supported by Bayer, Boehringer Ingelheim and Lilly Alliance, Bristol-Myers Squibb and Pfizer Alliance, Novartis Pharma AG and Vifor Pharma in the form of educational grants. The sponsors were not involved in the development of this platform and had no influence on its content.
Our mission: To reduce the burden of cardiovascular disease