Ismahel Hassan, Docherty Kieran F
BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK.
BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK.
Trends Cardiovasc Med. 2025 May 16. doi: 10.1016/j.tcm.2025.05.002.
Heart failure (HF) with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF) represents approximately half of all HF cases, yet therapeutic options are limited. Mineralocorticoid receptor (MR) overactivation by aldosterone has long been recognized as a key driver of vascular inflammation, cardiac fibrosis, and cardiac hypertrophy, pathophysiological processes integral to the development and progression of HFmrEF/HFpEF. The non-steroidal MRA finerenone has been developed with a distinct pharmacological profile: potent and selective MR blockade with a reduced risk of off-target hormone-related side effects. Large, multicenter randomized placebo-controlled trials in chronic kidney disease and type 2 diabetes patients (FIDELIO-DKD, FIGARO-DKD) first highlighted finerenone's cardiorenal benefits, including a reduction in death from cardiovascular causes and hospitalization for HF. More recently, the FINEARTS-HF trial extended this evidence to patients with HFmrEF/HFpEF, demonstrating a significant reduction in the risk of worsening HF events and death from cardiovascular causes. Ongoing studies, such as REDEFINE-HF, CONFIRMATION-HF, and FINALITY-HF, will examine the potential role of finerenone in HF across a broad spectrum of ejection fractions and different clinical settings. This review synthesizes the evolving evidence supporting the role of finerenone as a new option in the management of HF.
射血分数轻度降低或保留的心力衰竭（HFmrEF/HFpEF）约占所有心力衰竭病例的一半，但治疗选择有限。长期以来，醛固酮引起的盐皮质激素受体（MR）过度激活一直被认为是血管炎症、心脏纤维化和心脏肥大的关键驱动因素，这些病理生理过程是HFmrEF/HFpEF发生和发展不可或缺的一部分。非甾体类盐皮质激素受体拮抗剂非奈利酮具有独特的药理学特性：强效且选择性地阻断MR，降低了脱靶激素相关副作用的风险。在慢性肾病和2型糖尿病患者中进行的大型多中心随机安慰剂对照试验（FIDELIO-DKD、FIGARO-DKD）首次突出了非奈利酮对心肾的益处，包括降低心血管原因导致的死亡和因心力衰竭住院的风险。最近，FINEARTS-HF试验将这一证据扩展到了HFmrEF/HFpEF患者，表明HF事件恶化和心血管原因导致的死亡风险显著降低。正在进行的研究，如REDEFINE-HF、CONFIRMATION-HF和FINALITY-HF，将在广泛的射血分数范围和不同临床环境中研究非奈利酮在心力衰竭中的潜在作用。本综述综合了不断发展的证据，支持非奈利酮作为心力衰竭管理新选择的作用。
