PhD Scientific Days 2025

Poster Session I. - T: Cardiovascular Medicine and Research

Mineralocorticoid receptor antagonist therapy in patients with heart failure and sustained monomorphic ventricular tachycardia: a comparative analysis of spironolactone vs. eplerenone

Name of the presenter

Szakál Imre

Institute/workplace of the presenter

Semmelweis University Heart and Vascular Center

Authors

Imre Szakál¹, Ferenc Komlósi¹, Patrik Tóth¹, Bence Arnóth¹, Péter Vámosi¹, Gyula Bohus¹, Béla Merkely¹, László Gellér¹, Klaudia Vivien Nagy¹

1: Semmelweis University Heart and Vascular Center

Text of the abstract

Introduction: Mineralocorticoid receptor antagonists (MRAs) form part of the optimal medical therapy for chronic heart failure (HF) and have been shown to reduce all cause mortality and sudden cardiac death. However, direct comparisons of spironolactone and eplerenone in the context of ventricular arrhythmia recurrence are lacking.
Aim: to compare the effects of these two MRAs on all-cause mortality and recurrence of sustained, monomorphic ventricular tachycardia (VT) in patients with HF.
Methods: We analyzed data of HF patients with left ventricular ejection fraction (LVEF) below 50%, hospitalized for sustained, monomorphic VT, and receiving MRA therapy at discharge. We performed propensity score matching for 13 variables, including medical history, medication, and arrhythmia presentation. The endpoints were all‐cause mortality and VT recurrence.
Results: A total of 202 propensity score-matched patients were included. Median age was 67 [61-74] years and 87% were male. The median LVEF was 30% [25%-35%]. The median follow‐up duration was 32 [18-36] months, with a minimum follow‐up of 1 year. During follow-up, 70 patients died and VT recurrence was observed in 86 cases. There was no significant difference in all-cause mortality between the two MRAs (hazard ratio = 0.98 [0.62-1.57], p=0.94). However, eplerenone was associated with a significantly lower risk of VT recurrence compared to spironolactone (hazard ratio = 0.42 [0.26-0.66], p<0.001).
Conclusion: Eplerenone may be preferable over spironolactone to reduce arrhythmia recurrence in heart failure patients hospitalized for sustained, monomorphic VT.