Eplerenone in systemic right ventricle: Double blind randomized clinical trial. The evedes study
Por:
Dos, L, Pujadas, S, Estruch, M, Mas, A, Ferreira-Gonzalez, I, Pijuan, A, Serra, R, Ordonez-Llanos, J, Subirana, M, Pons-Llado, G, Marsal, JR, Garcia-Dorado, D, Casaldaliga, J
Publicada:
15 oct 2013
Resumen:
Background: There is no proven pharmacological strategy for the treatment of the failing systemic right ventricle (SRV) but myocardial fibrosis may play a role in its pathophysiology.
Methods: We designed a double-blind, placebo-controlled clinical trial to assess the effects of eplerenone 50 mg during 12 months on cardiac magnetic resonance parameters (SRV mass and ejection fraction) and neurohormonal and collagen turnover biomarker (CTB) levels.
Results: Twenty six patients with atrial switch repair for transposition of the great arteries were randomized to eplerenone (n = 14) or placebo (n = 12) and 14 healthy volunteers served as controls for comparison of baseline neurohormones and CTB levels. The study population showed a good baseline profile in terms of SRV mass (57.4 +/- 17 g/m(2)) and ejection fraction (54.9 +/- 7.5%). However, levels of N-terminal pro-brain natriuretic peptide (NT-proBNP), C terminal propeptide of type I procollagen (CICP) and C-terminal Telopeptide of type I Collagen (ICTP) were significantly elevated when compared to healthy controls. After one year of treatment, a trend toward reduction of CICP, N-terminal pro-Matrix Metalloproteinase 1 (NT-proMMP1), Tissue Inhibitor of Metalloproteinases 1 (TIMP1) and galectin 3 levels and a lower increase in ICTP in patients under eplerenone was observed. The reduction of SRV mass and the improvement of SRV function with eplerenone were not conclusive.
Conclusions: Patients with SRV treated with eplerenone showed an improvement of an altered baseline CTB profile suggesting that reduction of myocardial fibrosis might be a therapeutic target in these patients. (C) 2013 Elsevier Ireland Ltd. All rights reserved.
Filiaciones:
Dos, L:
Vall dHebron Univ Hosp, Integrated Adult Congenital Heart Dis Unit, Barcelona 08035, Spain
Santa Creu & St Pau Univ Hosp, Barcelona, Spain
Autonomous Univ Barcelona, E-08193 Barcelona, Spain
Pujadas, S:
Santa Creu & St Pau Univ Hosp, Dept Cardiol, Barcelona, Spain
Estruch, M:
Santa Creu & St Pau Univ Hosp, Dept Biochem, Barcelona, Spain
Mas, A:
Vall dHebron Univ Hosp, Integrated Adult Congenital Heart Dis Unit, Barcelona 08035, Spain
Santa Creu & St Pau Univ Hosp, Barcelona, Spain
Autonomous Univ Barcelona, E-08193 Barcelona, Spain
Ferreira-Gonzalez, I:
Vall dHebron Univ Hosp, Dept Cardiol, Barcelona 08035, Spain
Pijuan, A:
Vall dHebron Univ Hosp, Integrated Adult Congenital Heart Dis Unit, Barcelona 08035, Spain
Santa Creu & St Pau Univ Hosp, Barcelona, Spain
Autonomous Univ Barcelona, E-08193 Barcelona, Spain
Serra, R:
Santa Creu & St Pau Univ Hosp, Dept Cardiol, Barcelona, Spain
Ordonez-Llanos, J:
Santa Creu & St Pau Univ Hosp, Dept Biochem, Barcelona, Spain
Subirana, M:
Vall dHebron Univ Hosp, Integrated Adult Congenital Heart Dis Unit, Barcelona 08035, Spain
Santa Creu & St Pau Univ Hosp, Barcelona, Spain
Autonomous Univ Barcelona, E-08193 Barcelona, Spain
Pons-Llado, G:
Santa Creu & St Pau Univ Hosp, Dept Cardiol, Barcelona, Spain
Marsal, JR:
Vall dHebron Univ Hosp, Dept Cardiol, Barcelona 08035, Spain
Garcia-Dorado, D:
Vall dHebron Univ Hosp, Dept Cardiol, Barcelona 08035, Spain
Casaldaliga, J:
Vall dHebron Univ Hosp, Integrated Adult Congenital Heart Dis Unit, Barcelona 08035, Spain
Santa Creu & St Pau Univ Hosp, Barcelona, Spain
Autonomous Univ Barcelona, E-08193 Barcelona, Spain
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