Mineralocorticoid receptor antagonism: Therapeutic potential in acute heart failure syndromes

Mazen Albaghdadi, Mihai Gheorghiade, Bertram Pitt*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

33 Scopus citations

Abstract

Acute heart failure syndromes (AHFS) are a heterogeneous group of commonly encountered and difficult to manage clinical syndromes associated with high morbidity and mortality. Dyspnoea, pulmonary, and systemic congestion often characterize AHFS due to acutely elevated intracardiac filling pressures and fluid overload. Diuresis, respiratory support, vasodilator therapy, and gradual attenuation of the activation of reninangiotensinaldosterone system (RAAS) and sympathetic nervous system (SNS) are the keystones of AHFS management. Despite available therapies, post-discharge mortality and re-hospitalization rates remain unacceptably high in AHFS. Neurohumoral-mediated cardiorenal dysfunction and congestion may contribute to these high event rates. Mineralocorticoid receptor antagonists (MRAs) serve a dual therapeutic role by enhancing diuresis and attenuating the pathological effects of RAAS and SNS activation. Although these agents are indicated in patients with chronic, severe heart failure with reduced ejection fraction (HF/REF) and in patients with HF/REF post-myocardial infarction (MI), they have not been systematically studied in patients with AHFS. The purpose of this review is to explore the potential efficacy and safety of MRAs in AHFS.

Original languageEnglish (US)
Pages (from-to)2626-2633c
JournalEuropean heart journal
Volume32
Issue number21
DOIs
StatePublished - Nov 2011

Keywords

  • Acute heart failure syndromes (AHFS)
  • Aldosterone
  • Mineralocorticoid receptor antagonists (MRAs)
  • Neurohumoral
  • Reninangiotensinaldosterone system (RAAS)

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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