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首页> 外文期刊>ESC Heart Failure >Mineralocorticoid receptor antagonists for heart failure: a real‐life observational study
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Mineralocorticoid receptor antagonists for heart failure: a real‐life observational study

机译：盐皮质激素受体拮抗剂治疗心力衰竭：现实生活中的观察性研究

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Aims Mineralocorticoid receptor antagonists (MRAs) have been demonstrated to improve outcomes in reduced ejection fraction heart failure (HFrEF) patients. However, MRAs added to conventional treatment may lead to worsening of renal function and hyperkalaemia. We investigated, in a population‐based analysis, the long‐term effects of MRA treatment in HFrEF patients. Methods and results We analysed data of 6046 patients included in the Metabolic Exercise Cardiac Kidney Index score dataset. Analysis was performed in patients treated ( n ?=?3163) and not treated ( n ?=?2883) with MRA. The study endpoint was a composite of cardiovascular death, urgent heart transplantation, or left ventricular assist device implantation. Ten years' survival was analysed through Kaplan–Meier, compared by log‐rank test and propensity score matching. At 10?years' follow‐up, the MRA‐untreated group had a significantly lower number of events than the MRA‐treated group ( P ??0.001). MRA‐treated patients had more severe heart failure (higher New York Heart Association class and lower left ventricular ejection fraction, kidney function, and peak VO 2 ). At a propensity‐score‐matching analysis performed on 1587 patients, MRA‐treated and MRA‐untreated patients showed similar study endpoint values. Conclusions In conclusion, MRA treatment does not affect the composite of cardiovascular death, urgent heart transplantation or left ventricular assist device implantation in a real‐life setting. A meticulous patient follow‐up, as performed in trials, is likely needed to match the positive MRA‐related benefits observed in clinical trials.
机译：目的盐皮质激素受体拮抗剂（MRA）已被证明可以改善射血分数降低的心力衰竭（HFrEF）患者的预后。但是，常规治疗中添加的MRA可能导致肾功能恶化和高钾血症。在一项基于人群的分析中，我们调查了MRa治疗对HFrEF患者的长期疗效。方法和结果我们分析了包括在代谢运动心脏肾脏指数评分数据集中的6046例患者的数据。对接受MRA治疗的患者（n = 3163）和未治疗的患者（n = 2883）进行了分析。研究终点是心血管死亡，紧急心脏移植或左心室辅助装置植入的复合物。通过Kaplan-Meier分析了十年的生存期，并通过对数秩检验和倾向得分匹配进行了比较。在10年的随访中，未接受MRA治疗的组的事件数量明显少于接受MRA治疗的组（P <0.001）。经MRA治疗的患者有更严重的心力衰竭（纽约心脏协会等级较高，左心室射血分数，肾功能和VO 2峰值较低）。在对1587名患者进行的倾向评分匹配分析中，接受MRA治疗和未接受MRA治疗的患者显示出相似的研究终点值。结论总之，在现实生活中，MRA治疗不会影响心血管死亡，紧急心脏移植或左心室辅助装置植入的复合性。为了与临床试验中观察到的与MRA相关的积极益处相匹配，可能需要对试验进行认真的患者随访。

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