Key result
MRA use in early-stage HFpEF is linked to reduced LAVi and natriuretic peptide levels.
Why the study?
Benefits of MRAs in established HFpEF are reported, but their use is not well studied in early HFpEF without prior HF hospitalization.
Do mineralocorticoid receptor antagonists improve natriuretic peptide levels and echocardiographic parameters in patients with early-stage HFpEF without prior hospitalization?
Observational (n=197)
Do mineralocorticoid receptor antagonists improve natriuretic peptide levels and echocardiographic parameters in patients with early-stage HFpEF without prior hospitalization?
p-value: p=<0.0001
In patients with early-stage HFpEF without prior hospitalization, MRA treatment is associated with improvements in natriuretic peptide levels and left atrial volume index.
Hypothesis-generating for MRAs in early HFpEF; prospective randomized trials needed before clinical adoption.
Background: Hospitalization with a first episode of heart failure (HF) is a serious event associated with poor clinical outcomes in HF with preserved ejection fraction (HFpEF). Identification of HFpEF via detection of elevated left ventricular filling pressure at rest or during exercise may allow early intervention. Benefits of treatment with mineralocorticoid receptor antagonists (MRAs) in established HFpEF have been reported, but use of MRAs is not well studied in early HFpEF without prior HF hospitalization. Methods: We retrospectively studied 197 patients with HFpEF who did not have prior hospitalization but had been diagnosed by exercise stress echocardiography or catheterization. We examined changes in natriuretic peptide levels and echocardiographic parameters reflecting diastolic function following MRA initiation. Results: < 0.0001 in 50 patients with paired data). Similar results were observed for the changes in B-type natriuretic peptide levels. Reduction in the left atrial volume index was also greater in the MRA-treated group than in the non-MRA-treated group after a median 7-month follow-up (77 patients with paired echocardiographic data). Patients with lower left ventricular global longitudinal strain experienced a greater reduction in N-terminal pro-B-type natriuretic peptide levels following MRA treatment. In the safety assessment, MRA modestly decreased renal function but did not change potassium levels. Conclusions: Our results suggest that MRA treatment has potential benefits for early-stage HFpEF.
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Kagami et al. (2023) conducted an observational in Early-stage heart failure with preserved ejection fraction (HFpEF) (n=197). Mineralocorticoid receptor antagonists (MRAs) vs. Non-MRA-treated group was evaluated on Changes in natriuretic peptide levels and echocardiographic parameters reflecting diastolic function (p=<0.0001). Mineralocorticoid receptor antagonists in early-stage HFpEF reduced left atrial volume index and natriuretic peptide levels compared to no MRA treatment over a median 7-month follow-up.
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