Eplerenone in Heart Failure Treatment
Eplerenone in Heart Failure Treatment
Beta-blockers should be administered to all patients with heart failure stage II to IV
 according to NYHA.Beta-blockers reduce mortality and hospitalizations and improve the
 operational phase for all categories of patients with heart failure. Since beta-blockers,
 only carvedilol, metoprolol, bisoprolol and recently nevimpololi have shown these benefits
 and so, only they have evidence to be provided.

 Eplerenone is indicated, in addition to conventional therapy, for reducing the risk of
 cardiovascular mortality and morbidity in stable patients with left ventricular dysfunction
 (LVEF ≤ 40%) and clinically proven heart failure after recent myocardial infarction.
Heart Failure (HF) As heart failure is defined as a complex clinical syndrome that can result
 from any structural or functional cardiac disorder and affects the ability of the ventricle
 to accept or eject blood. Its incidence is increasing in recent years in the Western world.
 It is estimated that 6% - 10% of the population over 65 suffers from heart failure. The
 clinical picture of heart failure is shortness of breath, fatigue tolerance restriction and
 fluid retention that can lead to pulmonary congestion or peripheral edema. These symptoms and
 signs are not required to appear all at once in each patient. Some patients simply have a
 reduced exercise tolerance, while others dominate the swelling and do not report dyspnea or
 fatigue. For the diagnosis of heart failure is necessary apart from the existence of symptoms
 objective confirmation cardiac dysfunction, preferably by echocardiography, or more
 specialized and less available methods, such as magnetic resonance imaging heart and
 radionuclide ventriculography.

 Coronary heart disease is nowadays the dominant cause of heart failure, as 65-70% of patients
 with heart failure suffer from coronary disease. The cardiomyopathies and especially dilated,
 is the cause of heart failure in 20% of cases. The myocarditis, hyperthyroidism and abuse of
 ethanol, are responsible for a significant number of patients with type distending heart
 failure. Hypertension and valvular dominated in the past, occupy small percentage today as
 heart failure causes. The heart failure can be divided into right or left, depending on
 whether the predominant symptoms resulting from congestion of systemic or pulmonary veins,
 respectively. Moreover, heart failure is separated into systolic or diastolic depending on
 whether systolic or diastolic performance of the left ventricle is affected. In most patients
 with systolic heart failure and diastolic dysfunction coexist. However, in 30% of patients
 with heart failure is pure diastolic dysfunction.

 For the diagnosis of heart failure with diastolic dysfunction criteria require:

 1. In the presence of signs and symptoms of heart failure

 2. ejection fraction of the left ventricle> 45%

 3. the presence of one of three types of abnormal left ventricular filling during diastole
 (relaxation extension, restrictive type).

 There are four operating stages depending on the symptoms of patients with heart failure,
 according to the classification in NYHA (New York Heart Association). At the operational
 stage I patients have symptoms of heart failure at a high level of exercise, beyond the
 ordinary. In stage II, the symptoms appear in a regular exercise level at stage III in small
 fatigue, while in stage IV symptoms occur at rest, so that patients are unable to look after
 themselves. Medication and diet can alter the operating phase which is the patient, without
 any significant change occurs in ventricular performance. It is particularly interesting that
 there is little correlation between symptoms and systolic left ventricular performance as
 expressed by the ejection fraction. Thus, patients with low ejection fraction <25% can be
 virtually asymptomatic, while others slightly influenced ejection fraction have serious
 discomfort. Changes of abdominal diatasimotitas of pericardial voltage, any valvular
 deficiencies and especially the function of the right ventricle are those factors which
 together with systolic left ventricular performance determine the occurrence or not of the
 symptoms of heart failure patients. In heart failure the function of the left ventricle is
 gradually worsening even in the absence of new effect damaging agent. This is the famous
 remodeling (Cardiac Remodeling) of the left ventricle, during which the investigators
 dilatation, hypertrophy and more spherical the shape. Thus, the mechanical performance of the
 ventricle decreases, increasing the mitral insufficiency due to distension of the mitral
 annulus, and increases the parietal stress. Ventricular remodeling contribute to continuous
 deterioration of symptoms, despite any treatment. The activation of the neurohormonal system
 proved to be the most important factor in why the cardiac remodeling and the unfavorable
 development of heart failure. Patients with heart failure have in their plasma levels of
 noradrenaline, angiotensin II, aldosterone, endothelin and cytokines which may act
 deleteriously on the structure and functioning of the heart. The mobilization of
 neurohormonal mechanisms in heart failure causes fluid retention and sodium, peripheral
 vasoconstriction, myocardial fibrosis and toxic effect on myocardial cells, creating a
 vicious cycle of deteriorating architecture and performance of the failing heart.

 Ejection Fraction

 The relation between stroke volume, which is extruded from the left ventricle and the
 starting end diastole filling volume gives a measure of the contractile function of the left
 ventricle. Each patient with known cardiovascular disease should be subject to assessment of
 left ventricular function by measuring ejection fraction. Several studies have demonstrated
 that when the ejection fraction (LVEF), which measures the ability of the heart to eject
 blood into the aorta, not exceed 40% (natural rate ^ 50%) increased dramatically
 postinfarction mortality. The ejection fraction is a reliable prognostic indicator can be
 calculated by ultrasonography. The reduced ejection fraction is associated with an increased
 risk of life-threatening arrhythmias, heart failure and death. A low ejection fraction,
 particularly after myocardial infarction, is a strong indication for the administration of
 beta-blockers, as many studies have shown that administration of these drugs significantly
 reduces cardiovascular mortality.

 Rationale of the study

 This study intends to recruit within 6 months of clinical practice in the Greek reality
 regarding the data administration of eplerenone in addition to standard therapy including
 beta-blockers, to reduce the risk of cardiovascular mortality and morbidity in stable
 patients with dysfunction left ventricle (LVEF ≤ 40%) and clinically proven heart failure
 after recent myocardial infarction.
Inclusion Criteria:

 -  Eligible ages for the study:> 18 years

 -  Patients who are to receive eprelenone according to standard clinical practice

 -  Patients with heart failure of ischemic / non-ischemic etiology

 -  Patients receiving standard therapy including beta-blockers, to reduce the risk of
 cardiovascular mortality and morbidity

 -  Stable patients

 -  Patients with left ventricular dysfunction (LVEF ≤ 40%)

 -  Patients with clinically proven heart failure after recent myocardial infarction.

 -  Patients who have fully understood the study protocol and signed the consent form

 Exclusion Criteria:

 -  Patients <18 years

 -  Hypersensitivity to eplerenone in any of the excipients

 -  Patients with a serum potassium level> 5,0 mmol / L at the start of therapy

 -  Patients with moderate to severe renal impairment (creatinine clearance <50 mL / min)

 -  Patients with severe hepatic impairment (Child-Pugh class C)

 -  Patients taking diuretics guard potassium loss or strong inhibitors of CYP3A4 (eg
 itraconazole, ketoconazole, ritonavir, nelfinavir, clarithromycin, telithromycin and
 nefazodone)

 -  Patients who have not fully understood the study protocol and have not signed the
 consent form