The Role of Esaxerenone in the Continuum of Heart Failure With Preserved Ejection Fraction: Insights From a Prospective Observational Study

IF 2.4 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology Pub Date : 2025-04-24 DOI:10.1002/clc.70137

Takashi Naruke, Miho Hashimura-Kakogawa, Yoichi Suzuki, Yuki Ikeda, Lisa Kitasato, Takeru Nabeta, Yuki Usami-Naruke, Shunsuke Ishii, Jun Oikawa, Ryo Kameda, Yoshiyasu Minami, Hidehira Fukaya, Masaru Yuge, Takeo Kawaguchi, Junya Ako

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Abstract

Background

Heart failure with preserved ejection fraction (HFpEF) presents significant therapeutic challenges, particularly exacerbated by comorbidities such as hypertension and diabetes. The modulation of the Renin–Angiotensin–Aldosterone System is critical in managing HFpEF progression. Esaxerenone (ESAX), a selective mineralocorticoid receptor antagonist, may offer benefits in managing HFpEF continuum due to its unique mechanism.

Methods

Conducted at Odawara Municipal Hospital, this single-center, prospective, observational study involved hypertensive adult outpatients diagnosed with either type 2 diabetes mellitus or chronic kidney disease. Patients were categorized into HFpEF and pre-HFpEF groups based on established criteria. The study primarily assessed changes in blood pressure and cardiac function (through NT-proBNP levels and echocardiography), along with secondary outcomes including aortic stiffness and oxidative stress over a 24-week period.

Results

Both HFpEF and pre-HFpEF patients exhibited significant reductions in blood pressure, with no significant differences between the patients. HFpEF patients experienced decreases in NT-proBNP levels and oxidative stress similar to those in pre-HFpEF patients. Notably, pre-HFpEF patients demonstrated more pronounced improvements in cardiac function, particularly in the E/e' ratio and global longitudinal strain, compared to HFpEF patients. Additionally, 30% of pre-HFpEF patients had improved to stage A, suggesting potential for early intervention.

Conclusions

ESAX appears to be effective in managing the heart failure continuum, particularly benefiting pre-HFpEF patients. Its impacts suggest the potential benefits of early intervention in decelerating disease progression and potentially preventing the new onset of HFpEF, highlighting the importance of targeted therapies at early stages of heart failure.

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艾塞瑞酮在射血分数保留型心力衰竭中的作用：前瞻性观察研究的启示

背景：保留射血分数的心力衰竭（HFpEF）提出了重大的治疗挑战，特别是高血压和糖尿病等合并症加剧了这一挑战。肾素-血管紧张素-醛固酮系统的调节是控制HFpEF进展的关键。Esaxerenone （ESAX）是一种选择性矿皮质激素受体拮抗剂，由于其独特的机制，可能在治疗HFpEF连续体方面具有益处。方法在小田原市立医院进行的这项单中心、前瞻性、观察性研究纳入了诊断为2型糖尿病或慢性肾脏疾病的高血压成年门诊患者。根据既定标准，将患者分为HFpEF组和HFpEF前组。该研究主要评估了血压和心功能的变化（通过NT-proBNP水平和超声心动图），以及次要结果，包括24周期间的主动脉僵硬和氧化应激。结果HFpEF和术前患者血压均有显著降低，两组间无显著差异。HFpEF患者的NT-proBNP水平和氧化应激水平下降与HFpEF前患者相似。值得注意的是，与HFpEF患者相比，HFpEF前患者的心功能得到了更明显的改善，特别是在E/ E′比和整体纵向应变方面。此外，30%的hfpef前患者已改善到A期，提示早期干预的潜力。结论：ESAX在治疗心力衰竭方面是有效的，尤其是对hfpef前患者。其影响提示早期干预在减缓疾病进展和潜在预防HFpEF新发方面的潜在益处，突出了在心力衰竭早期阶段靶向治疗的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Cardiology 医学-心血管系统

CiteScore

5.10

自引率

3.70%

发文量

189

审稿时长

4-8 weeks

期刊介绍： Clinical Cardiology provides a fully Gold Open Access forum for the publication of original clinical research, as well as brief reviews of diagnostic and therapeutic issues in cardiovascular medicine and cardiovascular surgery. The journal includes Clinical Investigations, Reviews, free standing editorials and commentaries, and bonus online-only content. The journal also publishes supplements, Expert Panel Discussions, sponsored clinical Reviews, Trial Designs, and Quality and Outcomes.