Anti-remodelling effect of canrenone in patients with mild chronic heart failure (AREA IN-CHF study): Final results

Alessandro Boccanelli, Gian Francesco Mureddu, Giuseppe Cacciatore, Francesco Clemenza, Andrea Di Lenarda, Antonello Gavazzi, Maurizio Porcu, Roberto Latini, Donata Lucci, Aldo Pietro Maggioni, Serge Masson, Massimo Vanasia, Giovanni De Simone

Research output: Contribution to journalArticle

Abstract

AimsTo test whether canrenone, an aldosterone receptor antagonist, improves left ventricular (LV) remodelling in NYHA class II heart failure (HF). Aldosterone receptor antagonists improve outcome in severe HF, but no information is available in NYHA class II.Methods and resultsAREA IN-CHF is a randomized, double-blind, placebo-controlled study testing canrenone on top of optimal treatment in NYHA class II HF with low ejection fraction (EF) to assess 12-month changes in LV end-diastolic volume (LVEDV). Brain natriuretic peptide (BNP) was also measured. Information was available for 188 subjects on canrenone and 194 on placebo. Left ventricular end-diastolic volume was similarly reduced (-18) in both arms, but EF increased more (P = 0.04) in the canrenone (from 40 to 45) than in the placebo arm (from 40-43). Brain natriuretic peptide (n = 331) decreased more in the canrenone (-37) than in the placebo arm (-8; P <0.0001), paralleling a significant reduction in left atrial dimensions (-4 vs. 0.2; P = 0.02). The composite endpoint of cardiac death and hospitalization was significantly lower in the canrenone arm (8 vs. 15; P = 0.02). ConclusionCanrenone on top of optimal treatment for HF did not have additional effects on LVEDV, but it increased EF, and reduced left atrial size and circulating BNP, with potential beneficial effects on outcome. A large-scale randomized study should be implemented to confirm benefits on cardiovascular outcomes in patients with HF in NYHA class II.

Original languageEnglish
Pages (from-to)68-76
Number of pages9
JournalEuropean Journal of Heart Failure
Volume11
Issue number1
DOIs
Publication statusPublished - Jan 2009

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Canrenone
Heart Failure
Brain Natriuretic Peptide
Placebos
Mineralocorticoid Receptor Antagonists
Stroke Volume
Ventricular Remodeling
Treatment Failure
Hospitalization

Keywords

  • Aldosterone receptor antagonists
  • Brain natriuretic peptide
  • Diastolic function
  • Ejection fraction
  • Heart failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Anti-remodelling effect of canrenone in patients with mild chronic heart failure (AREA IN-CHF study) : Final results. / Boccanelli, Alessandro; Mureddu, Gian Francesco; Cacciatore, Giuseppe; Clemenza, Francesco; Di Lenarda, Andrea; Gavazzi, Antonello; Porcu, Maurizio; Latini, Roberto; Lucci, Donata; Maggioni, Aldo Pietro; Masson, Serge; Vanasia, Massimo; De Simone, Giovanni.

In: European Journal of Heart Failure, Vol. 11, No. 1, 01.2009, p. 68-76.

Research output: Contribution to journalArticle

Boccanelli, A, Mureddu, GF, Cacciatore, G, Clemenza, F, Di Lenarda, A, Gavazzi, A, Porcu, M, Latini, R, Lucci, D, Maggioni, AP, Masson, S, Vanasia, M & De Simone, G 2009, 'Anti-remodelling effect of canrenone in patients with mild chronic heart failure (AREA IN-CHF study): Final results', European Journal of Heart Failure, vol. 11, no. 1, pp. 68-76. https://doi.org/10.1093/eurjhf/hfn015
Boccanelli, Alessandro ; Mureddu, Gian Francesco ; Cacciatore, Giuseppe ; Clemenza, Francesco ; Di Lenarda, Andrea ; Gavazzi, Antonello ; Porcu, Maurizio ; Latini, Roberto ; Lucci, Donata ; Maggioni, Aldo Pietro ; Masson, Serge ; Vanasia, Massimo ; De Simone, Giovanni. / Anti-remodelling effect of canrenone in patients with mild chronic heart failure (AREA IN-CHF study) : Final results. In: European Journal of Heart Failure. 2009 ; Vol. 11, No. 1. pp. 68-76.
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abstract = "AimsTo test whether canrenone, an aldosterone receptor antagonist, improves left ventricular (LV) remodelling in NYHA class II heart failure (HF). Aldosterone receptor antagonists improve outcome in severe HF, but no information is available in NYHA class II.Methods and resultsAREA IN-CHF is a randomized, double-blind, placebo-controlled study testing canrenone on top of optimal treatment in NYHA class II HF with low ejection fraction (EF) to assess 12-month changes in LV end-diastolic volume (LVEDV). Brain natriuretic peptide (BNP) was also measured. Information was available for 188 subjects on canrenone and 194 on placebo. Left ventricular end-diastolic volume was similarly reduced (-18) in both arms, but EF increased more (P = 0.04) in the canrenone (from 40 to 45) than in the placebo arm (from 40-43). Brain natriuretic peptide (n = 331) decreased more in the canrenone (-37) than in the placebo arm (-8; P <0.0001), paralleling a significant reduction in left atrial dimensions (-4 vs. 0.2; P = 0.02). The composite endpoint of cardiac death and hospitalization was significantly lower in the canrenone arm (8 vs. 15; P = 0.02). ConclusionCanrenone on top of optimal treatment for HF did not have additional effects on LVEDV, but it increased EF, and reduced left atrial size and circulating BNP, with potential beneficial effects on outcome. A large-scale randomized study should be implemented to confirm benefits on cardiovascular outcomes in patients with HF in NYHA class II.",
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AU - Cacciatore, Giuseppe

AU - Clemenza, Francesco

AU - Di Lenarda, Andrea

AU - Gavazzi, Antonello

AU - Porcu, Maurizio

AU - Latini, Roberto

AU - Lucci, Donata

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AU - Masson, Serge

AU - Vanasia, Massimo

AU - De Simone, Giovanni

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N2 - AimsTo test whether canrenone, an aldosterone receptor antagonist, improves left ventricular (LV) remodelling in NYHA class II heart failure (HF). Aldosterone receptor antagonists improve outcome in severe HF, but no information is available in NYHA class II.Methods and resultsAREA IN-CHF is a randomized, double-blind, placebo-controlled study testing canrenone on top of optimal treatment in NYHA class II HF with low ejection fraction (EF) to assess 12-month changes in LV end-diastolic volume (LVEDV). Brain natriuretic peptide (BNP) was also measured. Information was available for 188 subjects on canrenone and 194 on placebo. Left ventricular end-diastolic volume was similarly reduced (-18) in both arms, but EF increased more (P = 0.04) in the canrenone (from 40 to 45) than in the placebo arm (from 40-43). Brain natriuretic peptide (n = 331) decreased more in the canrenone (-37) than in the placebo arm (-8; P <0.0001), paralleling a significant reduction in left atrial dimensions (-4 vs. 0.2; P = 0.02). The composite endpoint of cardiac death and hospitalization was significantly lower in the canrenone arm (8 vs. 15; P = 0.02). ConclusionCanrenone on top of optimal treatment for HF did not have additional effects on LVEDV, but it increased EF, and reduced left atrial size and circulating BNP, with potential beneficial effects on outcome. A large-scale randomized study should be implemented to confirm benefits on cardiovascular outcomes in patients with HF in NYHA class II.

AB - AimsTo test whether canrenone, an aldosterone receptor antagonist, improves left ventricular (LV) remodelling in NYHA class II heart failure (HF). Aldosterone receptor antagonists improve outcome in severe HF, but no information is available in NYHA class II.Methods and resultsAREA IN-CHF is a randomized, double-blind, placebo-controlled study testing canrenone on top of optimal treatment in NYHA class II HF with low ejection fraction (EF) to assess 12-month changes in LV end-diastolic volume (LVEDV). Brain natriuretic peptide (BNP) was also measured. Information was available for 188 subjects on canrenone and 194 on placebo. Left ventricular end-diastolic volume was similarly reduced (-18) in both arms, but EF increased more (P = 0.04) in the canrenone (from 40 to 45) than in the placebo arm (from 40-43). Brain natriuretic peptide (n = 331) decreased more in the canrenone (-37) than in the placebo arm (-8; P <0.0001), paralleling a significant reduction in left atrial dimensions (-4 vs. 0.2; P = 0.02). The composite endpoint of cardiac death and hospitalization was significantly lower in the canrenone arm (8 vs. 15; P = 0.02). ConclusionCanrenone on top of optimal treatment for HF did not have additional effects on LVEDV, but it increased EF, and reduced left atrial size and circulating BNP, with potential beneficial effects on outcome. A large-scale randomized study should be implemented to confirm benefits on cardiovascular outcomes in patients with HF in NYHA class II.

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KW - Ejection fraction

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