Effect of finerenone on cardiac remodeling and exercise capacity in patients with anterior ST-elevation myocardial infarction underwent primary percutaneous coronary intervention
S A F Sungkar, H Hendriarti Satoto, D Pesireron, H SuhartonoAbstract
Background
Cardiac remodeling post-myocardial infarction (MI) can occur even after successful coronary reperfusion, particularly in anterior ST-elevation myocardial infarction (STEMI). This remodeling process may lead to a decline in left ventricular (LV) fuction, cardiac output and exercise capacity thereby increasing the risk of major adverse cardiovascular events. Finerenone, a non-steroidal mineralocorticoid receptor antagonist, exerts anti-inflammatory and antifibrotic effects that may attenuate post-infarction remodeling. Studies evaluating the effects of finerenone on cardiac remodeling and exercise capacity in post MI patients are still very limited.
Purpose
to evaluate the effect of Finerenone on LV function, cardiac output (CO) and exercise capacity in patients with anterior STEMI who underwent primary percutaneous coronary intervention (PPCI).
Methods
This was a double-blind randomized controlled clinical trial involving patients with anterior STEMI and a left ventricular ejection fraction (LVEF) >40% who successfully underwent primary PCI. Participants received either Finerenone 10 mg daily (n = 27) or placebo (n = 25) for 60 days, in addition to standard medical therapy. LVEF and global longitudinal strain (GLS) as parameters of LV function and cardiac output was measured using echocardiography at predischarge and after 60 days of treatment. Exercise capacity was assessed by cardiopulmonary exercise testing (CPET).
Results
Baseline clinical characteristics were comparable between the two groups. After 60 days follow up, improvement of LVEF and GLS was greater in finerenone group compared with control group (Δ LVEF pre→post 4,62 ± 3,11% vs 2,16 ± 3,23%; p = 0.007; Δ GLS pre→post -3,22 ± 2,68% vs -1,60 ± 2,29; p = 0.024). The mean change in CO (Δ pre→post) was greater in the Finerenone group (+0.32 ± 1.03 vs −0.07 ± 1.17; p = 0.203), though not statistically significant. Exercise capacity parameters were also higher in the Finerenone group but did not reach statistical significance (peak VO2 23.6 ± 3.8 vs 21.6 ± 3.9 mL·kg−1·min−1, p = 0.084; oxygen pulse 12.5 ± 2.3 vs 11.6 ± 2.7 mL/beat, p = 0.216; METs 6.66 ± 1.24 vs 6.17 ± 1.10, p = 0.139). No clinically relevant adverse events related to Finerenone 10 mg were observed during the follow up.
Conclusions
Administration of Finerenone 10 mg for 60 days improve of LV function, while did not result in significant differences in cardiac output or exercise capacity compared with placebo in patients with anterior STEMI following primary PCI.Picture and diagram