Influence of aldosterone antagonists on markers of electrophysiological instability in patients with heart failure with mid-range ejection fraction after ST-segment elevation acute coronary syndrome in the short- and long-term periods

Aim. To compare the effect of long-term therapy with mineralocorticoid receptor antagonists (MCRA) on markers of electrophysiological instability in patients with heart failure with mid-range ejection fraction (HFmrEF) after ST-segment elevation acute coronary syndrome (STE-ACS) with revascularization.

Material and methods. We examined 60 patients with HFmrEF (LVEF=40-49%), who underwent STE-ACS with revascularization by percutaneous coronary intervention (PCI). Depending on the MCRA agent taken, the patients were divided into 2 groups: group 1 — eplerenone, group 2 — spironolactone. Electrocardiography (ECG) was carried out on the 1^st, 30^th days and 12 months after PCI.

Results. Adjusted dispersion indices of the QT interval and its parts (QTcd, JTcd, QTapcd, SubTcd) were determined as markers of sudden cardiac death. In the acute period of the disease, they significantly exceeded the values of the control group: QTcd by 174,8% (p<3,2*10^-5), JTcd by 5,8 times (p<0,005), SubTcd by 5,1 times (p<0,005). QTapcd was reduced by 55,2% (p<4,3*10^-5). Comparative analysis of the effect of studied drugs on markers of electrical instability over 12-month follow-up determined that eplerenone had a more significant effect, reducing the QTcd by 2 times (p<2,7*10^-5), bringing the QTapcd closer to the norm (p<0,002), reducing JTcd by 95,5% (p<2,7*10^-5), and decreasing the SubTcd by 5,4 times (p<1,7*10^-5).

Conclusion. Eplerenone is the drug of choice for reducing the risk of sudden cardiac death in patients with HFmrEF who underwent STE-ACS during revascularization by PCI, both in the short- and long-term periods of the disease.

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