Immediate Administration of Mineralocorticoid Receptor Antagonist Spironolactone Prevents Post-Infarct Left Ventricular Remodeling Associated With Suppression of a Marker of Myocardial Collagen Synthesis in Patients With First Anterior Acute Myocardial Infarction

Hayashi, Meiso; Tsutamoto, Takayoshi; Wada, Atsuyuki; Tsutsui, Takashi; Ishii, Chitose; Ohno, Keijin; Fujii, Masazumi; Taniguchi, Atsuhiko; Hamatani, Tomokazu; Nozato, Yoshitaka; Kataoka, Ken; Morigami, Naoki; Ohnishi, Masato; Kinoshita, Masahiko; Horie, Minoru

doi:10.1161/01.cir.0000068340.96506.0f

Cited by 289 publications

(126 citation statements)

References 23 publications

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“…[236][237][238][239][240][241][242][243][244][245][246][247] Aldosterone blockade by spironolactone was shown to reduce all-cause mortality in adults with symptomatic HF by 35% when it was added to standard HF therapy in the RALES trial (Randomized Aldactone Evaluation Study). 248 Subsequently, eplerenone was found to provide a similar survival benefit in adults with HF caused by LV dysfunction 249,250 In addition to improving survival and hospitalization rates, canrenone and spironolactone have been associated with reverse remodeling in adults with HF.…”

Section: Mineralocorticoid Antagonistsmentioning

confidence: 99%

Management of Cardiac Involvement Associated With Neuromuscular Diseases: A Scientific Statement From the American Heart Association

Feingold¹,

Mahle²,

Auerbach³

et al. 2017

Circulation

211

195

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For many neuromuscular diseases (NMDs), cardiac disease represents a major cause of morbidity and mortality. The management of cardiac disease in NMDs is made challenging by the broad clinical heterogeneity that exists among many NMDs and by limited knowledge about disease-specific cardiovascular pathogenesis and course-modifying interventions. The overlay of compromise in peripheral muscle function and other organ systems, such as the lungs, also makes the simple application of endorsed adult or pediatric heart failure guidelines to the NMD population problematic. In this statement, we provide background on several NMDs in which there is cardiac involvement, highlighting unique features of NMD-associated myocardial disease that require clinicians to tailor their approach to prevention and treatment of heart failure. Undoubtedly, further investigations are required to best inform future guidelines on NMD-specific cardiovascular health risks, treatments, and outcomes. N euromuscular diseases (NMDs) encompass a broad spectrum of diagnoses with overlapping but distinct phenotypes. Common to many NMDs is cardiac involvement. Although the past 3 decades have seen marked advances in our understanding of many NMDs, significant gaps in knowledge remain on how best to approach cardiac care in these patients. For example, survival in Duchenne muscular dystrophy (DMD) has been extended through the use of glucocorticoid use and respiratory support, yet cardiac complications remain a significant cause of morbidity and mortality.1-3 To achieve further gains in care, we will need to improve our understanding of the pathophysiologies driving cardiac involvement in NMDs and advance treatments aimed at preventing the progression of heart failure (HF) and sudden death in NMDs. The recently published findings of an expert working group on cardiac involvement in DMD, which outlined key gaps in knowledge and made specific recommendations aimed at improving diagnosis and management, are a step toward this goal. 4 In this statement, we include a comprehensive overview of the major categories of NMDs with cardiac involvement. For each, a brief background of the gene defect(s), common clinical manifestations (particularly cardiac findings), and current therapies is summarized. Gaps in knowledge are highlighted, and where possible, clinical treatment suggestions are made by the expert writing group appointed by the American Heart Association to review the available literature. Selection of the writing group was performed in accordance with the American Heart Association's conflict-of-interest management policy. Participants volunteered to write sections relevant to their expertise and experience. CLINICAL STATEMENTS AND GUIDELINESconducted a general search of the literature, restricted to human subjects research published between 1980 and 2016. Drafts of each section were written and sent to the chair of the writing group for incorporation into a single document, which was then edited. The edited document was discussed electron...

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Section: Mineralocorticoid Antagonistsmentioning

confidence: 99%

Management of Cardiac Involvement Associated With Neuromuscular Diseases: A Scientific Statement From the American Heart Association

Feingold¹,

Mahle²,

Auerbach³

et al. 2017

Circulation

211

195

View full text Add to dashboard Cite

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“…Hayashi et al25 investigated the early use of spironolactone immediately post percutaneous transluminal coronary angioplasty in patients with anterior STEMI and showed a reduction in postinfarct LV remodeling when used in combination with an angiotensin‐converting enzyme inhibitor. Recently, the Early Eplerenone Treatment in Patients With Acute ST‐Elevation Myocardial Infarction Without Heart Failure (REMINDER) trial investigated the effect of initiating oral eplerenone therapy 12 to 24 hours following STEMI admission (in the absence of HF) and reduced the incidence of patients with elevated serum brain natriuretic peptide/N‐terminal‐pro‐brain natriuretic peptide at ≥1 month after randomization, when compared with placebo 40.…”

Section: Discussionmentioning

confidence: 99%

“…Patients randomized to MRA therapy will receive an intravenous bolus of potassium canrenoate (200 mg, in keeping with the dose used initially by Hayashi et al25 and subsequently in the Aldosterone Blockade Early After Acute Myocardial Infarction [ ALBATROSS ] trial)26 followed by oral spironolactone 25 mg once daily for 2 weeks and then 50 mg once daily for the remaining 10 weeks, after which the MRA therapy will be stopped. Serum K + will be checked at 2 and 4 weeks.…”

Section: Methodsmentioning

confidence: 99%

Mineralocorticoid Receptor Antagonist Pretreatment to MINIMISE Reperfusion Injury After ST‐Elevation Myocardial Infarction (The MINIMISE STEMI Trial): Rationale and Study Design

Bulluck

Fröhlich

Mohdnazri

et al. 2015

Clinical Cardiology

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Novel therapies capable of reducing myocardial infarct (MI) size when administered prior to reperfusion are required to prevent the onset of heart failure in ST‐segment elevation myocardial infarction (STEMI) patients treated by primary percutaneous coronary intervention (PPCI). Experimental animal studies have demonstrated that mineralocorticoid receptor antagonist (MRA) therapy administered prior to reperfusion can reduce MI size, and MRA therapy prevents adverse left ventricular (LV) remodeling in post‐MI patients with LV impairment. With these 2 benefits in mind, we hypothesize that initiating MRA therapy prior to PPCI, followed by 3 months of oral MRA therapy, will reduce MI size and prevent adverse LV remodeling in STEMI patients. The MINIMISE‐STEMI trial is a prospective, randomized, double‐blind, placebo‐controlled trial that will recruit 150 STEMI patients from four centers in the United Kingdom. Patients will be randomized to receive either an intravenous bolus of MRA therapy (potassium canrenoate 200 mg) or matching placebo prior to PPCI, followed by oral spironolactone 50 mg once daily or matching placebo for 3 months. A cardiac magnetic resonance imaging scan will be performed within 1 week of PPCI and repeated at 3 months to assess MI size and LV remodeling. Enzymatic MI size will be estimated by the 48‐hour area‐under‐the‐curve serum cardiac enzymes. The primary endpoint of the study will be MI size on the 3‐month cardiac magnetic resonance imaging scan. The MINIMISE STEMI trial will investigate whether early MRA therapy, initiated prior to reperfusion, can reduce MI size and prevent adverse post‐MI LV remodeling.

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“…Although American College of Cardiology/American Heart Association/European Society of Cardiology guidelines recommend preoperative administration of β-blockers and amiodarone to prevent POAF, 7 no such guidelines have been developed in Japan and there have been no reports about angiotensin receptor antagonist or aldosterone blockers. It was reported that aldosterone blockers can prevent exacerbation of heart failure and cardiac fibrosis, [21][22][23] and Swedberg et al 24 recently demonstrated that the aldosterone blocker eplerenone decreased AF by 42% in patients with heart ACEi indicates angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; COPD, chronic obstructive pulmonary disease; and PAD, peripheral arterial disease. failure.…”

Section: Discussionmentioning

confidence: 99%

Carperitide and Atrial Fibrillation After Coronary Bypass Grafting

Sezai

Iida

Yoshitake

et al. 2015

Circ: Arrhythmia and Electrophysiology

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We previously performed a randomized controlled trial of carperitide (Daiichi-Sankyo Pharmaceutical Inc, Tokyo, Japan; Asubio Pharmaceuticals, Inc, Kobe, Japan), which inhibits the renin-angiotensin-aldosterone system (RAAS) and has strong natriuretic activity. We found that carperitide compensated for the adverse effects of extracorporeal circulation and inhibited left ventricular remodeling. [8][9][10][11] In the Nihon University working group study of low-dose HANP Infusion Therapy during cardiac surgery (NU-HIT) for Left Ventricular Dysfunction study, carperitide reduced the incidence of POAF, 8 but an antiarrhythmic effect of carperitide has not been reported in patients with heart failure and the mechanisms involved were unclear. Accordingly, the present study (NU-HIT trial for POAF) was performed to further evaluate the effect of carperitide on POAF and investigate factors related to AF.© 2015 American Heart Association, Inc. Original Article Circ Arrhythm ElectrophysiolBackground-Occurrence of atrial fibrillation after cardiac surgery is associated with long-term mortality. We investigated whether infusion of human atrial natriuretic peptide (carperitide) could prevent postoperative atrial fibrillation. Methods and Results-A total of 668 patients who underwent isolated coronary artery bypass grafting were randomized to receive infusion of carperitide or physiological saline from the initiation of cardiopulmonary bypass. Patients were monitored continuously for 1 week after surgery to detect atrial fibrillation. The risk factors were investigated by Cox proportional hazard model. Postoperative atrial fibrillation occurred in 41 of 335 patients (12.2%) from the carperitide group versus 110 of 333 patients (32.7%) from the placebo group (P<0.0001). Postoperative levels of angiotensin-II, aldosterone, creatine kinase MB isoenzyme, human heart fatty acid-binding protein, and brain natriuretic peptide were all significantly lower in the carperitide group. The risk factors for postoperative atrial fibrillation by the Cox proportional hazard model were an age ≥70 years, emergency surgery, preoperative aldosterone level >150 ng/mL, preoperative nonuse of angiotensin receptor antagonists, preoperative use of calcium antagonists, postoperative nonuse of β-blockers, postoperative nonuse of aldosterone blockers, and nonuse of carperitide. Conclusions-Perioperative Methods Study ProtocolThe NU-HIT trial for POAF was a randomized, double-blind, placebo-controlled study that enrolled patients undergoing isolated coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB). Patients who had cardiogenic shock, sinus bradycardia (≤50 per minutes at rest), atrioventricular block, hypothyroidism/hyperthyroidism, a history of AF or other arrhythmia, repeat CABG, and off-pump or on-pump beating CABG were excluded. Subjects were randomized preoperatively by the envelope method to the carperitide group receiving infusion of carperitide from initiation of CPB or the placebo group receiving physiological saline. In Ja...

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Immediate Administration of Mineralocorticoid Receptor Antagonist Spironolactone Prevents Post-Infarct Left Ventricular Remodeling Associated With Suppression of a Marker of Myocardial Collagen Synthesis in Patients With First Anterior Acute Myocardial Infarction

Cited by 289 publications

References 23 publications

Management of Cardiac Involvement Associated With Neuromuscular Diseases: A Scientific Statement From the American Heart Association

Management of Cardiac Involvement Associated With Neuromuscular Diseases: A Scientific Statement From the American Heart Association

Mineralocorticoid Receptor Antagonist Pretreatment to MINIMISE Reperfusion Injury After ST‐Elevation Myocardial Infarction (The MINIMISE STEMI Trial): Rationale and Study Design

Carperitide and Atrial Fibrillation After Coronary Bypass Grafting

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