Anti-remodelling effect of canrenone in patients with mild chronic heart failure (AREA IN-CHF study): final results
Anti-remodelling effect of canrenone in patients with mild chronic heart failure (AREA IN-CHF study): final results
复制标题
DOI：
10.1093/eurjhf/hfn015
复制
发表时间：
2009-01-01
影响因子：
18.2
通讯作者：
de Simone, Giovanni
中科院分区：
文献类型：
--
作者：
Boccanelli, Alessandro;Mureddu, Gian Francesco;de Simone, Giovanni
目的 测试醛固酮受体拮抗剂坎利酮是否可以改善 NYHA II 级心力衰竭 (HF) 患者的左心室 (LV) 重构。醛固酮受体拮抗剂可改善严重心力衰竭的预后，但尚无 NYHA II 级患者的信息。 方法和结果 AREA IN-CHF 是一项随机、双盲、安慰剂对照研究，在射血分数 (EF) 较低的 NYHA II 级心力衰竭患者的最佳治疗基础上测试坎利酮，以评估 12 个月左室舒张末期容积 (LVEDV) 的变化。还测量了脑钠尿肽（BNP）。获得了 188 名受试者服用坎利酮的信息和 194 名受试者服用安慰剂的信息。两组的左心室舒张末期容积同样减少（-18%），但坎利酮组的 EF 增加更多（P = 0.04）（从 40% 到 45%），而安慰剂组（从 40-43%）则增加更多（P = 0.04）。坎利酮组 (-37%) 的脑钠尿肽 (n = 331) 比安慰剂组 (-8%; P < 0.0001) 下降更多，同时左心房尺寸也显着减小 (-4% vs. 0.2%; P = 0.02)。 Canrenone 组的心源性死亡和住院治疗复合终点显着较低（8% vs. 15%；P = 0.02）。结论 Canrenone 在心力衰竭最佳治疗基础上对 LVEDV 没有额外影响，但它增加了 EF，并减少了左心房大小和循环 BNP，对结果具有潜在的有益影响。应进行大规模随机研究来确认 NYHA II 级心力衰竭患者心血管结局的益处。
Aims To test whether canrenone, an aldosterone receptor antagonist, improves left ventricular (LV) remodelling in NYHA class II heart failure (HF). Aldosterone receptor antagonists improve outcome in severe HF, but no information is available in NYHA class II.Methods and results AREA IN-CHF is a randomized, double-blind, placebo-controlled study testing canrenone on top of optimal treatment in NYHA class II HF with tow ejection fraction (EF) to assess 12-month changes in LV end-diastolic volume (LVEDV). Brain natriuretic peptide (BNP) was also measured. Information was available for 188 subjects on canrenone and 194 on placebo. Left ventricular end-diastolic volume was similarly reduced (-18%) in both arms, but EF increased more (P = 0.04) in the canrenone (from 40% to 45%) than in the placebo arm (from 40-43%). Brain natriuretic peptide (n = 331) decreased more in the canrenone (-37%) than in the placebo arm (-8%; P < 0.0001), paralleling a significant reduction in left atrial dimensions (-4% vs. 0.2%; P = 0.02). The composite end-point of cardiac death and hospitalization was significantly lower in the canrenone arm (8% vs. 15%; P = 0.02).Conclusion Canrenone on top of optimal treatment for HF did not have additional effects on LVEDV, but it increased EF, and reduced left atrial size and circulating BNP, with potential beneficial effects on outcome. A large-scale randomized study should be implemented to confirm benefits on cardiovascular outcomes in patients with HF in NYHA class II.