Chang Joycie, Ambrosy Andrew P, Vardeny Orly, Van Spall Harriette G C, Mentz Robert J, Sauer Andrew J
Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA; University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA.
Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA; Division of Research, Kaiser Permanente Northern California, Pleasanton, California, USA.
JACC Heart Fail. 2024 Dec;12(12):1979-1993. doi: 10.1016/j.jchf.2024.08.007. Epub 2024 Sep 1.
The pathophysiology of heart failure (HF) is related to the overactivation of the mineralocorticoid receptor, leading to fluid retention and adverse myocardial remodeling. Although mineralocorticoid receptor antagonists (MRAs) are recommended for the treatment of heart failure with reduced ejection fraction (HFrEF), they remain underused due to adverse effects such as hyperkalemia; and their efficacy is controversial in heart failure with mildly reduced ejection fraction (HFmrEF) and heart failure with preserved ejection fraction (HFpEF). Recent trials in people with diabetes and kidney disease have supported the use of nonsteroidal MRAs in reducing HF-related morbidity and mortality and have fewer side effects than their steroidal counterparts. The efficacy and safety of nonsteroidal MRAs have not been tested in HF and are currently being evaluated in additional clinical trials. This review comprehensively examines the current data regarding MRAs for HF and the future direction of nonsteroidal MRA research while exploring the causes of MRA underutilization.
心力衰竭（HF）的病理生理学与盐皮质激素受体过度激活有关，导致液体潴留和不良的心肌重塑。尽管盐皮质激素受体拮抗剂（MRAs）被推荐用于治疗射血分数降低的心力衰竭（HFrEF），但由于高钾血症等不良反应，它们的使用仍然不足；并且它们在射血分数轻度降低的心力衰竭（HFmrEF）和射血分数保留的心力衰竭（HFpEF）中的疗效存在争议。最近在糖尿病和肾病患者中进行的试验支持使用非甾体类MRAs来降低与HF相关的发病率和死亡率，并且其副作用比甾体类MRAs少。非甾体类MRAs的疗效和安全性尚未在HF中进行测试，目前正在其他临床试验中进行评估。本综述全面审视了关于MRAs治疗HF的当前数据以及非甾体类MRA研究的未来方向，同时探讨了MRA未得到充分利用的原因。
