Boccanelli Alessandro, Mureddu Gian Francesco, Cacciatore Giuseppe, Clemenza Francesco, Di Lenarda Andrea, Gavazzi Antonello, Porcu Maurizio, Latini Roberto, Lucci Donata, Maggioni Aldo Pietro, Masson Serge, Vanasia Massimo, de Simone Giovanni
Department of Cardiovascular Diseases, San Giovanni-Addolorata Hospital, Roma, Italy.
Eur J Heart Fail. 2009 Jan;11(1):68-76. doi: 10.1093/eurjhf/hfn015.
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.
AREA IN-CHF is a randomized, double-blind, placebo-controlled study testing canrenone on top of optimal treatment in NYHA class II HF with low 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 endpoint of cardiac death and hospitalization was significantly lower in the canrenone arm (8% vs. 15%; P = 0.02).
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.
检验醛固酮受体拮抗剂坎利酮是否能改善纽约心脏协会（NYHA）心功能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重度HF患者的预后，但NYHA心功能II级患者的相关信息尚不可知。
“心力衰竭中的醛固酮受体拮抗剂评估研究（AREA IN-CHF）”是一项随机、双盲、安慰剂对照研究，在NYHA心功能II级、低射血分数（EF）的HF患者的最佳治疗基础上加用坎利酮，以评估12个月时左心室舒张末期容积（LVEDV）的变化。同时还测量了脑钠肽（BNP）。共有188名接受坎利酮治疗的受试者和194名接受安慰剂治疗的受试者纳入研究。两组患者的左心室舒张末期容积均有相似程度的降低（-18%），但坎利酮组的EF升高幅度更大（P = 0.04）（从40%升至45%），而安慰剂组从40%升至43%。脑钠肽（n = 331）在坎利酮组的下降幅度更大（-37%），高于安慰剂组（-8%；P < 0.0001），同时左心房尺寸显著缩小（-4% vs. 0.2%；P = 0.02）。坎利酮组心脏死亡和住院的复合终点显著低于安慰剂组（8% vs. 15%；P = 0.02）。
在HF的最佳治疗基础上加用坎利酮对LVEDV没有额外影响，但可增加EF，缩小左心房尺寸并降低循环BNP水平，对预后可能有有益影响。应开展大规模随机研究以证实对NYHA心功能II级HF患者心血管预后的益处。
