Finerenone in the treatment of cardiac failure in patients with hypertrophic cardiomyopathy

Background Heart failure (HF) is one of the main symptoms of hypertrophic cardiomyopathy (HCM). Currently, there is no evidence base for recommendations on treatment of heart failure with preserved ejection fraction (HFpEF) in HCM. The FINEARTS-HF study proved the effectiveness of finerenone in patients with HF regardless of the ejection fraction. Purpose of the study is to evaluate the effectiveness and safety of finerenone as an addition to basic therapy in patients with HCM with HFpEF. Methods 19 patients with HCM were examined, including 10 men, mean age 49.2±11.2 years. Severe family history (HCM and SCD) 8 patients. Obstructive form 10 patients. Comorbidity, diabetes mellitus 4 patients, arterial hypertension 12, atrial fibrillation 9, coronary artery disease 7 patients. Basic therapy – beta-blockers (100%), SGLT2 inhibitors (47%), ARBs (89.5%), ranolazine (26.3%). Duration of additional therapy with finerenone – from 3 to 13 months (average – 6.2 months). Examination methods – echocardiography, Holter ECG, laboratory tests – NT-pro-BNP, potassium, creatinine. Results Addition of finerenone therapy contributed to the reduction of heart failure symptoms (shortness of breath, increased tolerance to physical exertion). There was a decrease in the frequency of complaints of palpitations from 50% to 12.5% (p=0.03), shortness of breath from 87.5% to 56.25% (p=0.06) and weakness from 62.5% to 25% (p=0.03). In each of the examined patients with HCM, a decrease in NT-pro-BNP levels was noted from 38% to 182%, on average 79.9%. The mean level decreases from 1304.1±791.3 pg/ml to 754.1±345.7 pg/ml (p=0.012). The degree of decrease depended on the baseline level and was most noticeable at higher baseline levels. Two patients reached normal levels. The positive dynamics of NT-pro-BNP levels did not depend on the presence and severity of chronic kidney disease. According to the results of echocardiography, there was a tendency to increase the LV DRR from 4.5±0.5 to 4.6±0.5 cm (p=0.06), stroke volume from 61.4 (52.9-82.6) to 67.8 (51.9-77.3) ml (p=0.06), minute blood flow volume from 3.8 (3.2-5.2) to 4.3 (3.5-5.1) l/min (p=0.08) and a decrease in the E/e`mean index from 11.7 (10.4-13.4) to 10.2 (8.7-13.1) (p=0.05). No cases of side effects that would contribute to drug withdrawal (hyperkalemia, increased creatinine) were observed. Conclusion Finerenone is an effective and safe drug in the treatment of HF in HCM, but larger clinical studies are needed.