Impact of eplerenone on cardiovascular outcomes in heart failure patients with hypokalaemia.
Identifieur interne : 000B63 ( PubMed/Corpus ); précédent : 000B62; suivant : 000B64Impact of eplerenone on cardiovascular outcomes in heart failure patients with hypokalaemia.
Auteurs : Patrick Rossignol ; Nicolas Girerd ; George Bakris ; Orly Vardeny ; Brian Claggett ; John J V. Mcmurray ; Karl Swedberg ; Henry Krum ; Dirk J. Van Veldhuisen ; Harry Shi ; Sean Spanyers ; John Vincent ; Renaud Fay ; Zohra Lamiral ; Scott D. Solomon ; Faiez Zannad ; Bertram PittSource :
- European journal of heart failure [ 1879-0844 ] ; 2017.
Abstract
Although hypokalaemia is common among patients with heart failure (HF), the prognostic significance of baseline hypokalaemia and hypokalaemia during follow-up in HF patients receiving a mineralocorticoid receptor antagonist (MRA) remains uncertain.
DOI: 10.1002/ejhf.688
PubMed: 27868385
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Mcmurray</name><affiliation><nlm:affiliation>The British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.</nlm:affiliation></affiliation></author><author><name sortKey="Swedberg, Karl" sort="Swedberg, Karl" uniqKey="Swedberg K" first="Karl" last="Swedberg">Karl Swedberg</name><affiliation><nlm:affiliation>Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.</nlm:affiliation></affiliation></author><author><name sortKey="Krum, Henry" sort="Krum, Henry" uniqKey="Krum H" first="Henry" last="Krum">Henry Krum</name><affiliation><nlm:affiliation>Monash University, Melbourne, VIC, Australia.</nlm:affiliation></affiliation></author><author><name sortKey="Van Veldhuisen, Dirk J" sort="Van Veldhuisen, Dirk J" uniqKey="Van Veldhuisen D" first="Dirk J" last="Van Veldhuisen">Dirk J. Van Veldhuisen</name><affiliation><nlm:affiliation>University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.</nlm:affiliation></affiliation></author><author><name sortKey="Shi, Harry" sort="Shi, Harry" uniqKey="Shi H" first="Harry" last="Shi">Harry Shi</name><affiliation><nlm:affiliation>Pfizer, NY, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Spanyers, Sean" sort="Spanyers, Sean" uniqKey="Spanyers S" first="Sean" last="Spanyers">Sean Spanyers</name><affiliation><nlm:affiliation>Pfizer, NY, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Vincent, John" sort="Vincent, John" uniqKey="Vincent J" first="John" last="Vincent">John Vincent</name><affiliation><nlm:affiliation>Pfizer, NY, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Fay, Renaud" sort="Fay, Renaud" uniqKey="Fay R" first="Renaud" last="Fay">Renaud Fay</name><affiliation><nlm:affiliation>Inserm, Centre d'Investigations Cliniques-Plurithématique 14-33, and Inserm U1116, Nancy, France.</nlm:affiliation></affiliation></author><author><name sortKey="Lamiral, Zohra" sort="Lamiral, Zohra" uniqKey="Lamiral Z" first="Zohra" last="Lamiral">Zohra Lamiral</name><affiliation><nlm:affiliation>Inserm, Centre d'Investigations Cliniques-Plurithématique 14-33, and Inserm U1116, Nancy, France.</nlm:affiliation></affiliation></author><author><name sortKey="Solomon, Scott D" sort="Solomon, Scott D" uniqKey="Solomon S" first="Scott D" last="Solomon">Scott D. Solomon</name><affiliation><nlm:affiliation>Brigham and Women's Hospital, Boston, MA, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Zannad, Faiez" sort="Zannad, Faiez" uniqKey="Zannad F" first="Faiez" last="Zannad">Faiez Zannad</name><affiliation><nlm:affiliation>Inserm, Centre d'Investigations Cliniques-Plurithématique 14-33, and Inserm U1116, Nancy, France.</nlm:affiliation></affiliation></author><author><name sortKey="Pitt, Bertram" sort="Pitt, Bertram" uniqKey="Pitt B" first="Bertram" last="Pitt">Bertram Pitt</name><affiliation><nlm:affiliation>University of Michigan School of Medicine, Ann Arbor, MI, USA.</nlm:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2017">2017</date><idno type="RBID">pubmed:27868385</idno><idno type="pmid">27868385</idno><idno type="doi">10.1002/ejhf.688</idno><idno type="wicri:Area/PubMed/Corpus">000B63</idno><idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Corpus" wicri:corpus="PubMed">000B63</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Impact of eplerenone on cardiovascular outcomes in heart failure patients with hypokalaemia.</title><author><name sortKey="Rossignol, Patrick" sort="Rossignol, Patrick" uniqKey="Rossignol P" first="Patrick" last="Rossignol">Patrick Rossignol</name><affiliation><nlm:affiliation>Inserm, Centre d'Investigations Cliniques-Plurithématique 14-33, and Inserm U1116, Nancy, France.</nlm:affiliation></affiliation></author><author><name sortKey="Girerd, Nicolas" sort="Girerd, Nicolas" uniqKey="Girerd N" first="Nicolas" last="Girerd">Nicolas Girerd</name><affiliation><nlm:affiliation>Inserm, Centre d'Investigations Cliniques-Plurithématique 14-33, and Inserm U1116, Nancy, France.</nlm:affiliation></affiliation></author><author><name sortKey="Bakris, George" sort="Bakris, George" uniqKey="Bakris G" first="George" last="Bakris">George Bakris</name><affiliation><nlm:affiliation>ASH Comprehensive Hypertension Center, The University of Chicago Medicine, Chicago, IL, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Vardeny, Orly" sort="Vardeny, Orly" uniqKey="Vardeny O" first="Orly" last="Vardeny">Orly Vardeny</name><affiliation><nlm:affiliation>University of Wisconsin School of Pharmacy, Madison, WI, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Claggett, Brian" sort="Claggett, Brian" uniqKey="Claggett B" first="Brian" last="Claggett">Brian Claggett</name><affiliation><nlm:affiliation>Brigham and Women's Hospital, Boston, MA, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Mcmurray, John J V" sort="Mcmurray, John J V" uniqKey="Mcmurray J" first="John J V" last="Mcmurray">John J V. Mcmurray</name><affiliation><nlm:affiliation>The British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.</nlm:affiliation></affiliation></author><author><name sortKey="Swedberg, Karl" sort="Swedberg, Karl" uniqKey="Swedberg K" first="Karl" last="Swedberg">Karl Swedberg</name><affiliation><nlm:affiliation>Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.</nlm:affiliation></affiliation></author><author><name sortKey="Krum, Henry" sort="Krum, Henry" uniqKey="Krum H" first="Henry" last="Krum">Henry Krum</name><affiliation><nlm:affiliation>Monash University, Melbourne, VIC, Australia.</nlm:affiliation></affiliation></author><author><name sortKey="Van Veldhuisen, Dirk J" sort="Van Veldhuisen, Dirk J" uniqKey="Van Veldhuisen D" first="Dirk J" last="Van Veldhuisen">Dirk J. Van Veldhuisen</name><affiliation><nlm:affiliation>University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.</nlm:affiliation></affiliation></author><author><name sortKey="Shi, Harry" sort="Shi, Harry" uniqKey="Shi H" first="Harry" last="Shi">Harry Shi</name><affiliation><nlm:affiliation>Pfizer, NY, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Spanyers, Sean" sort="Spanyers, Sean" uniqKey="Spanyers S" first="Sean" last="Spanyers">Sean Spanyers</name><affiliation><nlm:affiliation>Pfizer, NY, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Vincent, John" sort="Vincent, John" uniqKey="Vincent J" first="John" last="Vincent">John Vincent</name><affiliation><nlm:affiliation>Pfizer, NY, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Fay, Renaud" sort="Fay, Renaud" uniqKey="Fay R" first="Renaud" last="Fay">Renaud Fay</name><affiliation><nlm:affiliation>Inserm, Centre d'Investigations Cliniques-Plurithématique 14-33, and Inserm U1116, Nancy, France.</nlm:affiliation></affiliation></author><author><name sortKey="Lamiral, Zohra" sort="Lamiral, Zohra" uniqKey="Lamiral Z" first="Zohra" last="Lamiral">Zohra Lamiral</name><affiliation><nlm:affiliation>Inserm, Centre d'Investigations Cliniques-Plurithématique 14-33, and Inserm U1116, Nancy, France.</nlm:affiliation></affiliation></author><author><name sortKey="Solomon, Scott D" sort="Solomon, Scott D" uniqKey="Solomon S" first="Scott D" last="Solomon">Scott D. Solomon</name><affiliation><nlm:affiliation>Brigham and Women's Hospital, Boston, MA, USA.</nlm:affiliation></affiliation></author><author><name sortKey="Zannad, Faiez" sort="Zannad, Faiez" uniqKey="Zannad F" first="Faiez" last="Zannad">Faiez Zannad</name><affiliation><nlm:affiliation>Inserm, Centre d'Investigations Cliniques-Plurithématique 14-33, and Inserm U1116, Nancy, France.</nlm:affiliation></affiliation></author><author><name sortKey="Pitt, Bertram" sort="Pitt, Bertram" uniqKey="Pitt B" first="Bertram" last="Pitt">Bertram Pitt</name><affiliation><nlm:affiliation>University of Michigan School of Medicine, Ann Arbor, MI, USA.</nlm:affiliation></affiliation></author></analytic><series><title level="j">European journal of heart failure</title><idno type="eISSN">1879-0844</idno><imprint><date when="2017" type="published">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Although hypokalaemia is common among patients with heart failure (HF), the prognostic significance of baseline hypokalaemia and hypokalaemia during follow-up in HF patients receiving a mineralocorticoid receptor antagonist (MRA) remains uncertain.</div></front></TEI><pubmed><MedlineCitation Status="In-Process" Owner="NLM"><PMID Version="1">27868385</PMID><DateCreated><Year>2016</Year><Month>11</Month><Day>21</Day></DateCreated><DateRevised><Year>2017</Year><Month>06</Month><Day>06</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1879-0844</ISSN><JournalIssue CitedMedium="Internet"><Volume>19</Volume><Issue>6</Issue><PubDate><Year>2017</Year><Month>Jun</Month></PubDate></JournalIssue><Title>European journal of heart failure</Title><ISOAbbreviation>Eur. J. Heart Fail.</ISOAbbreviation></Journal><ArticleTitle>Impact of eplerenone on cardiovascular outcomes in heart failure patients with hypokalaemia.</ArticleTitle><Pagination><MedlinePgn>792-799</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1002/ejhf.688</ELocationID><Abstract><AbstractText Label="AIMS" NlmCategory="OBJECTIVE">Although hypokalaemia is common among patients with heart failure (HF), the prognostic significance of baseline hypokalaemia and hypokalaemia during follow-up in HF patients receiving a mineralocorticoid receptor antagonist (MRA) remains uncertain.</AbstractText><AbstractText Label="METHODS AND RESULTS" NlmCategory="RESULTS">Results of the EMPHASIS-HF trial in patients (n = 2737) with HF and reduced EF with mild symptoms, randomized to eplerenone or placebo, were analysed with regard to the presence or occurrence of hypokalaemia (serum K(+) <4.0 mmol/L) and the risk of cardiovascular death or hospitalization for HF (primary endpoint). Median follow-up was 21 months. Baseline hypokalaemia and hypokalaemia during follow-up were common occurrences (19.6% and 40.6%, respectively). Hypokalaemia during follow-up was associated with worse outcomes in multivariable analyses [hazard ratio (HR) 1.26, 95% confidence interval (CI) 1.05-1.52, P = 0.01] without evidence of interaction with eplerenone. In contrast, baseline hypokalaemia was associated with outcomes in the placebo group (HR 1.37, 95% CI 1.05-1.79, P = 0.02) but not in the eplerenone group (HR 0.87, 95% CI 0.62-1.23, P = 0.44; P for interaction = 0.04). Concurrently, eplerenone was found to be more protective in patients with baseline hypokalaemia vs. patients without baseline hypokalaemia compared with placebo (HR 0.44, 95% 0.30-0.64, P < 0.0001 vs. 0.69, 95% CI 0.57-0.83, P = 0.0001; P for interaction = 0.04). In patients without baseline hypokalaemia, eplerenone use decreased the rate of hypokalaemia during follow-up (HR 0.69, 95% CI 0.59-0.80, P < 0.001). A potassium level >4.0 mmol/L at 1 month after randomization mediated 26.0% (0.6-51.4%) of the eplerenone treatment effect (P = 0.04).</AbstractText><AbstractText Label="CONCLUSION" NlmCategory="CONCLUSIONS">In HF patients receiving optimal therapy but not treated with eplerenone, baseline hypokalaemia was associated with worse outcomes. Conversely, hypokalaemia amplified the treatment effect of eplerenone.</AbstractText><CopyrightInformation>© 2016 The Authors. European Journal of Heart Failure © 2016 European Society of Cardiology.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Rossignol</LastName><ForeName>Patrick</ForeName><Initials>P</Initials><AffiliationInfo><Affiliation>Inserm, Centre d'Investigations Cliniques-Plurithématique 14-33, and Inserm U1116, Nancy, France.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>CHU Nancy, Pôle de Cardiologie, Vandoeuvre lès Nancy, France.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Université de Lorraine, France.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Girerd</LastName><ForeName>Nicolas</ForeName><Initials>N</Initials><AffiliationInfo><Affiliation>Inserm, Centre d'Investigations Cliniques-Plurithématique 14-33, and Inserm U1116, Nancy, France.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>CHU Nancy, Pôle de Cardiologie, Vandoeuvre lès Nancy, France.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Université de Lorraine, France.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Bakris</LastName><ForeName>George</ForeName><Initials>G</Initials><AffiliationInfo><Affiliation>ASH Comprehensive Hypertension Center, The University of Chicago Medicine, Chicago, IL, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Vardeny</LastName><ForeName>Orly</ForeName><Initials>O</Initials><AffiliationInfo><Affiliation>University of Wisconsin School of Pharmacy, Madison, WI, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Claggett</LastName><ForeName>Brian</ForeName><Initials>B</Initials><AffiliationInfo><Affiliation>Brigham and Women's Hospital, Boston, MA, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>McMurray</LastName><ForeName>John J V</ForeName><Initials>JJV</Initials><AffiliationInfo><Affiliation>The British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Swedberg</LastName><ForeName>Karl</ForeName><Initials>K</Initials><AffiliationInfo><Affiliation>Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Krum</LastName><ForeName>Henry</ForeName><Initials>H</Initials><AffiliationInfo><Affiliation>Monash University, Melbourne, VIC, Australia.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>van Veldhuisen</LastName><ForeName>Dirk J</ForeName><Initials>DJ</Initials><AffiliationInfo><Affiliation>University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Shi</LastName><ForeName>Harry</ForeName><Initials>H</Initials><AffiliationInfo><Affiliation>Pfizer, NY, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Spanyers</LastName><ForeName>Sean</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Pfizer, NY, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Vincent</LastName><ForeName>John</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Pfizer, NY, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Fay</LastName><ForeName>Renaud</ForeName><Initials>R</Initials><AffiliationInfo><Affiliation>Inserm, Centre d'Investigations Cliniques-Plurithématique 14-33, and Inserm U1116, Nancy, France.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>CHU Nancy, Pôle de Cardiologie, Vandoeuvre lès Nancy, France.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Université de Lorraine, France.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Lamiral</LastName><ForeName>Zohra</ForeName><Initials>Z</Initials><AffiliationInfo><Affiliation>Inserm, Centre d'Investigations Cliniques-Plurithématique 14-33, and Inserm U1116, Nancy, France.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>CHU Nancy, Pôle de Cardiologie, Vandoeuvre lès Nancy, France.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Université de Lorraine, France.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Solomon</LastName><ForeName>Scott D</ForeName><Initials>SD</Initials><AffiliationInfo><Affiliation>Brigham and Women's Hospital, Boston, MA, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Zannad</LastName><ForeName>Faiez</ForeName><Initials>F</Initials><AffiliationInfo><Affiliation>Inserm, Centre d'Investigations Cliniques-Plurithématique 14-33, and Inserm U1116, Nancy, France.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>CHU Nancy, Pôle de Cardiologie, Vandoeuvre lès Nancy, France.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Université de Lorraine, France.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Pitt</LastName><ForeName>Bertram</ForeName><Initials>B</Initials><AffiliationInfo><Affiliation>University of Michigan School of Medicine, Ann Arbor, MI, USA.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2016</Year><Month>11</Month><Day>20</Day></ArticleDate></Article><MedlineJournalInfo><Country>England</Country><MedlineTA>Eur J Heart Fail</MedlineTA><NlmUniqueID>100887595</NlmUniqueID><ISSNLinking>1388-9842</ISSNLinking></MedlineJournalInfo><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">Eplerenone</Keyword><Keyword MajorTopicYN="N">Heart failure</Keyword><Keyword MajorTopicYN="N">Potassium</Keyword><Keyword MajorTopicYN="N">Prognosis</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2015</Year><Month>11</Month><Day>24</Day></PubMedPubDate><PubMedPubDate PubStatus="revised"><Year>2016</Year><Month>10</Month><Day>02</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2016</Year><Month>10</Month><Day>08</Day></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2016</Year><Month>11</Month><Day>22</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2016</Year><Month>11</Month><Day>22</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2016</Year><Month>11</Month><Day>22</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">27868385</ArticleId><ArticleId IdType="doi">10.1002/ejhf.688</ArticleId></ArticleIdList></PubmedData></pubmed></record>Pour manipuler ce document sous Unix (Dilib)
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