Tinti Maria Denitza, De Gennaro Luisa, D'Elia Emilia, Benvenuto Manuela, Cittar Marco, Limonta Raul, De Maria Renata, Carigi Samuela, Bianco Matteo, Di Nora Concetta, Manca Paolo, Matassini Maria Vittoria, Rizzello Vittoria, Palmieri Vittorio, Battistoni Ilaria, Tagliamonte Gianluigi, Masarone Daniele, Halasz Geza, Iacovoni Attilio, Iacoviello Massimo, Colivicchi Furio, Grimaldi Massimo, Oliva Fabrizio, Gori Mauro
U.O.C. Cardiologia, A.O. San Camillo Forlanini, Roma - U.O.C. Cardiologia, A.O. San Camillo Forlanini, Roma.
U.O.C. Cardiologia 1, Dipartimento Cardiovascolare, ASST Papa Giovanni XXIII, Bergamo.
G Ital Cardiol (Rome). 2025 Jan;26(1):38-49. doi: 10.1714/4394.43958.
Mineralocorticoid receptor antagonists (MRAs) represent one of the cornerstones of treatment for heart failure with reduced ejection fraction. Post-hoc data from the TOPCAT trial, conducted in patients with heart failure mildly reduced or preserved ejection fraction (HFmrEF/HFpEF), suggest the possible clinical benefit of MRAs, particularly for slightly reduced ejection fraction values. The advent of non-steroidal MRAs, including finerenone, seems to represent a turning point in the treatment for HFmrEF/HFpEF. The favorable results of the trials conducted with finerenone in diabetic patients with chronic kidney disease suggested that this MRA might indeed improve outcomes in HFmrEF and HFpEF, considering that these comorbidities are strongly represented in this patient population. The anti-fibrotic and anti-inflammatory effects of finerenone represents the pathophysiological background for benefit in these patients. Moreover, due to its peculiar pharmacokinetic and pharmacodynamic properties, finerenone was found to be effective in reducing the risk of adverse events typically associated with MRAs. The results of the FINEARTS-HF trial, a phase 3 study including patients with HFmrEF and HFpEF randomized to receive finerenone or placebo, were presented at the 2024 ESC congress: finerenone was associated with a lower rate of heart failure-related events and cardiovascular mortality and may thus represent a new therapeutic option in this patient population.
盐皮质激素受体拮抗剂（MRAs）是射血分数降低的心力衰竭治疗的基石之一。在射血分数轻度降低或保留的心力衰竭（HFmrEF/HFpEF）患者中进行的TOPCAT试验的事后数据表明，MRAs可能具有临床益处，特别是对于射血分数轻度降低的情况。包括非奈利酮在内的非甾体类MRAs的出现，似乎代表了HFmrEF/HFpEF治疗的一个转折点。在患有慢性肾病的糖尿病患者中使用非奈利酮进行的试验取得了良好结果，这表明考虑到这些合并症在该患者群体中很常见，这种MRAs可能确实会改善HFmrEF和HFpEF患者的预后。非奈利酮的抗纤维化和抗炎作用是其对这些患者有益的病理生理基础。此外，由于其独特的药代动力学和药效学特性，发现非奈利酮可有效降低通常与MRAs相关的不良事件风险。FINEARTS-HF试验（一项3期研究，纳入HFmrEF和HFpEF患者，随机接受非奈利酮或安慰剂）的结果在2024年欧洲心脏病学会大会上公布：非奈利酮与较低的心力衰竭相关事件发生率和心血管死亡率相关，因此可能代表了该患者群体的一种新的治疗选择。
