NEW ASPECTS OF TREATMENT OF CHRONIC HEARTFAILURE: FOCUS ON ANTAGONISTS OFMINERALOCORTICOID RECEPTORS

Abstract

Introduction. The article presents evidence of the efficacy and safety of the use of receptor blockers
aldosterone, which were obtained in the implementation of several randomized clinical trials. Presents
the first experience of application of the selective antagonist of mineralocorticoid receptors in clinical
practice.
The aim of the study was to assess the effect of the antagonist of mineralocorticoid receptors of
eplerenone on the functional state of patients with heart failure, dynamics of the LV ejection fraction and
the concentration of brain natriuretic peptide in the blood.
Materials and methods: study design – uncontrolled clinical trial. We selected 30 patients
hospitalized in the cardiology department № 2 emergency Hospital clinic of chronic heart failure in the
decompensation stage. After careful analysis, previous therapy, the patient made adjustments
according to the latest recommendations on the appointment of the drug eplerenone in a dosage of 25
mg/day, once, with subsequent titration up to 50 mg/day. Statistical processing of the actual material
was carried out using the software packages SPSS version 20.0. The commonly used indicators were
calculated: the arithmetic mean (M), median (Me), mode (M0), 95% confidence interval (CI 95). The
Student's coefficient (t) was calculated to justify the reliability of differences in the variables studied.
Differences between the compared variables at p <0.05 were considered reliable.
Results and conclusions: the study included 21 men (70%) and 9 women (30%) the average age
of the patients was 57,9 ± 3,3 years. All patients had a detailed clinical picture of heart failure, functional
class NYHA of CHF were III (56%) and IV (44%). In the primary analysis of the data of
echocardiography, the average left ventricular ejection fraction was 37,5 ± 2,7 per cent. Brain natriuretic
peptide (BNP) were determined selectively, examinees was average BNP – 475,7 ± 3,9 pg/ml. At the
control examination, the average LVEF was 45,4 ± 1,5%, and the average creatinine and potassium
was 108 ± 2,1 mcmol/l and 5,2 ± 0,9 mmol/l respectively.
Conclusion: AMS is an obligatory component of therapy of CHF. Eplerenone showed its
effectiveness in improving functional status, increasing LV EF in patients with CHF decompensation.