title: Anti-remodelling effect of canrenone in patients with mild chronic heart failure (AREA IN-CHF study): final results.
abstract: OBJECTIVE
  To test whether canrenone, an aldosterone receptor antagonist, improves left ventricular (LV) remodelling in NYHA class II heart failure (HF). Aldosterone receptor antagonists improve outcome in severe HF, but no information is available in NYHA class II.
  
  
  RESULTS
  AREA IN-CHF is a randomized, double-blind, placebo-controlled study testing canrenone on top of optimal treatment in NYHA class II HF with low ejection fraction (EF) to assess 12-month changes in LV end-diastolic volume (LVEDV). Brain natriuretic peptide (BNP) was also measured. Information was available for 188 subjects on canrenone and 194 on placebo. Left ventricular end-diastolic volume was similarly reduced (-18%) in both arms, but EF increased more (P = 0.04) in the canrenone (from 40% to 45%) than in the placebo arm (from 40-43%). Brain natriuretic peptide (n = 331) decreased more in the canrenone (-37%) than in the placebo arm (-8%; P < 0.0001), paralleling a significant reduction in left atrial dimensions (-4% vs. 0.2%; P = 0.02). The composite endpoint of cardiac death and hospitalization was significantly lower in the canrenone arm (8% vs. 15%; P = 0.02).
  
  
  CONCLUSIONS
  Canrenone on top of optimal treatment for HF did not have additional effects on LVEDV, but it increased EF, and reduced left atrial size and circulating BNP, with potential beneficial effects on outcome. A large-scale randomized study should be implemented to confirm benefits on cardiovascular outcomes in patients with HF in NYHA class II.
authors.affiliation: Department of Cardiovascular Diseases, San Giovanni-Addolorata Hospital, Roma, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Boccanelli
authors.forename: Gian Francesco
authors.initials: GF
authors.lastname: Mureddu
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Cacciatore
authors.forename: Francesco
authors.initials: F
authors.lastname: Clemenza
authors.forename: Andrea
authors.initials: A
authors.lastname: Di Lenarda
authors.forename: Antonello
authors.initials: A
authors.lastname: Gavazzi
authors.forename: Maurizio
authors.initials: M
authors.lastname: Porcu
authors.forename: Roberto
authors.initials: R
authors.lastname: Latini
authors.forename: Donata
authors.initials: D
authors.lastname: Lucci
authors.forename: Aldo Pietro
authors.initials: AP
authors.lastname: Maggioni
authors.forename: Serge
authors.initials: S
authors.lastname: Masson
authors.forename: Massimo
authors.initials: M
authors.lastname: Vanasia
authors.forename: Giovanni
authors.initials: G
authors.lastname: de Simone
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002192:Canrenone / Q000494:pharmacology*; D002908:Chronic Disease; D003404:Creatinine / Q000097:blood; D004311:Double-Blind Method; D005260:Female; D006333:Heart Failure / Q000145:classification / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000494:pharmacology*; D020097:Natriuretic Peptide, Brain / Q000097:blood; D016896:Treatment Outcome; D014463:Ultrasonography; D020257:Ventricular Remodeling / Q000187:drug effects*; D055815:Young Adult
chemical_list: D000451:Mineralocorticoid Receptor Antagonists; D020097:Natriuretic Peptide, Brain; D002192:Canrenone; D003404:Creatinine