Mineralocorticoid receptor antagonist in heart failure: Past, present and future perspectives

Enrico Vizzardi, Valentina Regazzoni, Giorgio Caretta, Mara Gavazzoni, Edoardo Sciatti, Ivano Bonadei, Eleftheria Trichaki, Riccardo Raddino, Marco Metra
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引用次数: 23

Abstract

Aldosterone is involved in various deleterious effects on the cardiovascular system, including sodium and fluid retention, myocardial fibrosis, vascular stiffening, endothelial dysfunction, catecholamine release and stimulation of cardiac arrhythmias. Therefore, aldosterone receptor blockade may have several potential benefits in patients with cardiovascular disease. Mineralocorticoid receptor antagonists (MRAs) have been shown to prevent many of the maladaptive effects of aldosterone, in particular among patients with heart failure (HF). Randomized controlled trials have demonstrated efficacy of MRA in heart failure with reduced ejection fraction, both in patients with NYHA functional classes III and IV and in asymptomatic and mildly symptomatic patients (NYHA classes I and II). Recent data in patients with heart failure with preserved ejection fraction are encouraging. MRA could also have anti-arrhythmic effects on atrial and ventricular arrhythmias and may be helpful in patient ischemic heart disease through prevention of myocardial fibrosis and vascular damage. This article aims to discuss the pathophysiological effects of aldosterone in patients with cardiovascular disease and to review the current data that support the use of MRA in heart failure.

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心力衰竭的矿化皮质激素受体拮抗剂:过去,现在和未来的观点
醛固酮参与对心血管系统的各种有害影响,包括钠和液体潴留、心肌纤维化、血管硬化、内皮功能障碍、儿茶酚胺释放和心律失常的刺激。因此,醛固酮受体阻断可能对心血管疾病患者有几个潜在的益处。矿化皮质激素受体拮抗剂(MRAs)已被证明可以预防醛固酮的许多不良反应,特别是在心力衰竭(HF)患者中。随机对照试验已经证明了MRA在NYHA功能等级III和IV以及无症状和轻度症状(NYHA等级I和II)的心力衰竭患者中具有射血分数降低的疗效。最近在保留射血分数的心力衰竭患者中的数据令人鼓舞。MRA还可能对心房和室性心律失常具有抗心律失常作用,并可能通过预防心肌纤维化和血管损伤而有助于缺血性心脏病患者。本文旨在讨论醛固酮在心血管疾病患者中的病理生理作用,并回顾目前支持MRA在心力衰竭中的应用的数据。
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