Effect of Mineralocorticoid Receptor Antagonists on the Prognosis of Patients with Ventricular Tachyarrhythmias

Abstract

<b><i>Introduction:</i></b> The study sought to assess the effect of treatment with mineralocorticoid receptor antagonists (MRAs) on long-term prognosis of patients with systolic heart failure (HF) surviving index episodes of ventricular tachyarrhythmias. <b><i>Methods:</i></b> A large retrospective registry was used including consecutive HF patients with left ventricular ejection fraction <45% and index episodes of ventricular tachyarrhythmias from 2002 to 2015. The primary endpoint was all-cause mortality at 3 years and secondary endpoints were rehospitalization, as well as the composite endpoint consisting of recurrent ventricular tachyarrhythmias, sudden cardiac death and appropriate implantabe cardioverter defibrillator (ICD) therapies at 3 years. <b><i>Results:</i></b> 748 patients were included, 20% treated with MRA and 80% without. At 3 years, treatment with MRA was not associated with improved all-cause mortality (22% vs. 24%, log-rank <i>p</i> = 0.968; hazard ratio (HR) = 1.008; 95% CI 0.690–1.472; <i>p</i> = 0.968). Accordingly, risk of the composite endpoint (28% vs. 27%; HR = 1.131; 95% CI 0.806–1.589; <i>p</i> = 0.476) and first cardiac rehospitalization (24% vs. 22%; HR = 1.139; 95% CI 0.788–1.648; <i>p</i> = 0.489) were not affected by treatment with MRA. <b><i>Conclusion:</i></b> In patients with ventricular tachyarrhythmias, treatment with MRA was not associated with improved all-cause mortality at 3 years. The therapeutic effect of MRA treatment in patients with ventricular tachyarrhythmias needs to be reinvestigated within further randomized controlled trials.

Do Elderly Patients with Heart Failure and Reduced Ejection Fraction Benefit from Pharmacological Strategies for Prevention of Arrhythmic Events?

“…Regarding the therapeutic role of MRA treatment in patients with VA, it has been explored in a retrospective registry recently published. In HF survivors after ventricular tachyarrhythmia (LVEF ≤45%, mean age 66 years, 20% women), treatment with MRA was not associated with improved all-cause mortality at 3 years follow-up [55]. However, only 20% of patients with HF who survived ventricular tachyarrhythmia were discharged with MRA.…”

Correlation between Balthazar CT grading, CECT necrosis volume, attenuation value, and prognosis of patients with acute necrotizing pancreatitis

“…[12][13][14] Some studies have shown that the change of urea nitrogen in the early stage of patients with AP is related to the prognosis, and the results of this study are inconsistent with them, which may be due to the differences in the disease characteristics of the included patients and the limitation of sample size. [15][16][17][18] Balthazar CT grading is a grading method to evaluate the lesions of pancreatic parenchyma and surrounding tissues according to pancreatic morphology, inflammation and other conditions. [19,20] Studies have shown that the larger the volume of necrosis in the pancreas and peripancreatic area, the higher the density of necrosis, the slower the absorption and dissipation, the more serious the erosion effect on peripancreatic tissue, and the larger the CT attenuation value.…”