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Left ventricular remodeling after acute myocardial infarction: does eplerenone have an effect?
Am Heart J. 2009 Jun; 157(6):1088-96.AH

Abstract

AIMS

Aldosterone antagonism reduces cardiovascular morbidity and mortality in patients with left ventricular (LV) systolic dysfunction and heart failure or diabetes after acute myocardial infarction (AMI). The mechanism of this effect is unclear. We performed a contrast-enhanced cardiac magnetic resonance study to assess the effects of eplerenone on LV remodeling after AMI.

METHODS

One hundred patients (mean age, 58.9 +/- 12 years; 77% male) with LV systolic dysfunction but without heart failure or diabetes were randomized to 24 weeks' double-blind treatment with eplerenone or placebo started 1 to 14 days after AMI. Contrast-enhanced cardiac magnetic resonance was performed, and plasma concentrations of matrix metalloproteinase-2 (MMP-2) and MMP-9 were measured before randomization and at 12 and 24 weeks.

RESULTS

Baseline LV ejection fraction was, by chance, significantly higher in eplerenone than in placebo-treated patients. Eplerenone had no effect on the primary end point (change in LV end-systolic volume index); after covariate adjustment, the primary end point fell by 6.1 +/- 2.7 mL/m2 with eplerenone compared to placebo (P = .027), and LV end-diastolic volume index fell by 7.5 +/- 3.4 mL/m2 (P = .031); eplerenone did not significantly influence LV ejection fraction. Eplerenone, after covariate adjustment, significantly decreased MMP-2 and increased MMP-9 over 24 weeks relative to placebo.

CONCLUSIONS

In a population of patients with AMI with high uptake of contemporary antiremodeling therapy, eplerenone provides modest incremental protection against LV remodeling, only after covariate adjustment.

Authors+Show Affiliations

Cardiology Department, Western Infirmary, Glasgow, Scotland, United Kingdom. robinweir75@hotmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

19464421

Citation

Weir, Robin A P., et al. "Left Ventricular Remodeling After Acute Myocardial Infarction: Does Eplerenone Have an Effect?" American Heart Journal, vol. 157, no. 6, 2009, pp. 1088-96.
Weir RA, Mark PB, Petrie CJ, et al. Left ventricular remodeling after acute myocardial infarction: does eplerenone have an effect? Am Heart J. 2009;157(6):1088-96.
Weir, R. A., Mark, P. B., Petrie, C. J., Clements, S., Steedman, T., Ford, I., Ng, L. L., Squire, I. B., Wagner, G. S., McMurray, J. J., & Dargie, H. J. (2009). Left ventricular remodeling after acute myocardial infarction: does eplerenone have an effect? American Heart Journal, 157(6), 1088-96. https://doi.org/10.1016/j.ahj.2009.04.001
Weir RA, et al. Left Ventricular Remodeling After Acute Myocardial Infarction: Does Eplerenone Have an Effect. Am Heart J. 2009;157(6):1088-96. PubMed PMID: 19464421.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Left ventricular remodeling after acute myocardial infarction: does eplerenone have an effect? AU - Weir,Robin A P, AU - Mark,Patrick B, AU - Petrie,Colin J, AU - Clements,Suzanne, AU - Steedman,Tracey, AU - Ford,Ian, AU - Ng,Leong L, AU - Squire,Iain B, AU - Wagner,Galen S, AU - McMurray,John J V, AU - Dargie,Henry J, PY - 2008/11/16/received PY - 2009/04/02/accepted PY - 2009/5/26/entrez PY - 2009/5/26/pubmed PY - 2009/6/17/medline SP - 1088 EP - 96 JF - American heart journal JO - Am. Heart J. VL - 157 IS - 6 N2 - AIMS: Aldosterone antagonism reduces cardiovascular morbidity and mortality in patients with left ventricular (LV) systolic dysfunction and heart failure or diabetes after acute myocardial infarction (AMI). The mechanism of this effect is unclear. We performed a contrast-enhanced cardiac magnetic resonance study to assess the effects of eplerenone on LV remodeling after AMI. METHODS: One hundred patients (mean age, 58.9 +/- 12 years; 77% male) with LV systolic dysfunction but without heart failure or diabetes were randomized to 24 weeks' double-blind treatment with eplerenone or placebo started 1 to 14 days after AMI. Contrast-enhanced cardiac magnetic resonance was performed, and plasma concentrations of matrix metalloproteinase-2 (MMP-2) and MMP-9 were measured before randomization and at 12 and 24 weeks. RESULTS: Baseline LV ejection fraction was, by chance, significantly higher in eplerenone than in placebo-treated patients. Eplerenone had no effect on the primary end point (change in LV end-systolic volume index); after covariate adjustment, the primary end point fell by 6.1 +/- 2.7 mL/m2 with eplerenone compared to placebo (P = .027), and LV end-diastolic volume index fell by 7.5 +/- 3.4 mL/m2 (P = .031); eplerenone did not significantly influence LV ejection fraction. Eplerenone, after covariate adjustment, significantly decreased MMP-2 and increased MMP-9 over 24 weeks relative to placebo. CONCLUSIONS: In a population of patients with AMI with high uptake of contemporary antiremodeling therapy, eplerenone provides modest incremental protection against LV remodeling, only after covariate adjustment. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/19464421/Left_ventricular_remodeling_after_acute_myocardial_infarction:_does_eplerenone_have_an_effect L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-8703(09)00271-3 DB - PRIME DP - Unbound Medicine ER -