Echocardiographic Changes with Mineralocorticoid Antagonists in Heart Failure

• Published in: Journal of cardiac failure Vol. 25; no. 8; p. S42
• Main Authors: Delfiner, Matthew S., Dillane, Catherine, Kaoukis, Rania, Haddad, Abdullah, Schwartz, Daniel R., Keane, Martin G.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01-08-2019
• ISSN: 1071-9164; 1532-8414
• DOI: 10.1016/j.cardfail.2019.07.116

Mineralocorticoid receptor antagonists (MRA) have been shown to improve mortality in patients with heart failure (HF) with reduced ejection fraction (EF) and morbidity in those with preserved EF. It is unknown if cardiac anatomy changes over time in patients prescribed MRAs compared to those without a prescription.
Patients prescribed MRAs have improved echocardiographic measurements compared to controls.
The electronic medical record was queried to find patients with heart failure who were prescribed MRA along with age-matched controls. Each subject had been prescribed a beta blocker (BB), renin-angiotensin-aldosterone blockade (RAAS), had creatinine clearance greater than 30 mL/min and serum potassium less than 5 mmol/L. For each subject, two transthoracic echocardiograms (TTE) in the hospital image archive were quantitated and compared in a blinded fashion by three echocardiologists. Baseline TTEs were at least 3 months after initiating BB and RAAS therapy. Follow-up TTEs were at least 3 months after MRA prescription. For controls, follow-up TTEs were selected using the mean date-difference in MRA TTEs. Subgroup analyses were performed based on age and gender due to aldosterone-mediated effects associated with these factors. Continuous variables were analyzed with linear regression and categorical variables with logistic regression. All analyses controlled for the time difference between the two TTEs.
Seventy-two subjects were identified: 29 MRA-treated (40%) and 43 controls (60%). Twenty-two (78%) MRA subjects and 29 (67%) controls had a baseline EF below 45% (p = 0.44). For the entire population, there were no significant echocardiographic changes between the MRA and control patients. For subjects over the age of 65 years, the mean change in left ventricular mass index (LVMI) was -13.3 g/m2 for MRA subjects and 17.4 g/m2 for control subjects (p=0.035). For the same population, left atrial volume index increased (+4.5 ml/m2) for MRA subjects and decreased (-3.9 ml/m2) for control subjects (p=0.06). The ejection fraction (EF) increased by 8.3% for the MRA subjects and did not change for control subjects (p=0.53). There were no differences in the gender subgroup.
LVMI deceased over time for individuals over the age of 65 years and prescribed MRA. EF increased, and while this measurement did not reach statistical significance, the sample size was small. These favorable echocardiographic changes may explain the clinical benefits of MRA therapy in HF.