title: Mineralocorticoid receptor antagonism: therapeutic potential in acute heart failure syndromes.
abstract: Acute heart failure syndromes (AHFS) are a heterogeneous group of commonly encountered and difficult to manage clinical syndromes associated with high morbidity and mortality. Dyspnoea, pulmonary, and systemic congestion often characterize AHFS due to acutely elevated intracardiac filling pressures and fluid overload. Diuresis, respiratory support, vasodilator therapy, and gradual attenuation of the activation of renin-angiotensin-aldosterone system (RAAS) and sympathetic nervous system (SNS) are the keystones of AHFS management. Despite available therapies, post-discharge mortality and re-hospitalization rates remain unacceptably high in AHFS. Neurohumoral-mediated cardiorenal dysfunction and congestion may contribute to these high event rates. Mineralocorticoid receptor antagonists (MRAs) serve a dual therapeutic role by enhancing diuresis and attenuating the pathological effects of RAAS and SNS activation. Although these agents are indicated in patients with chronic, severe heart failure with reduced ejection fraction (HF/REF) and in patients with HF/REF post-myocardial infarction (MI), they have not been systematically studied in patients with AHFS. The purpose of this review is to explore the potential efficacy and safety of MRAs in AHFS.
authors.affiliation: Division of Cardiology, Department of Medicine,  Northwestern University Feinberg School of Medicine, 676 North St Clair, Suite 600, Chicago, IL 60611,  USA.
authors.forename: Mazen
authors.initials: M
authors.lastname: Albaghdadi
authors.forename: Mihai
authors.initials: M
authors.lastname: Gheorghiade
authors.forename: Bertram
authors.initials: B
authors.lastname: Pitt
mesh_terms: D000208:Acute Disease; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001145:Arrhythmias, Cardiac / Q000209:etiology; D059347:Cardio-Renal Syndrome / Q000209:etiology; D016757:Death, Sudden, Cardiac / Q000209:etiology; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D006973:Hypertension / Q000209:etiology; D000451:Mineralocorticoid Receptor Antagonists; D018377:Neurotransmitter Agents / Q000502:physiology; D012084:Renin-Angiotensin System / Q000187:drug effects / Q000502:physiology; D049994:Sodium Potassium Chloride Symporter Inhibitors / Q000627:therapeutic use; D013564:Sympathetic Nervous System / Q000187:drug effects / Q000502:physiology; D020257:Ventricular Remodeling / Q000502:physiology; D014883:Water-Electrolyte Imbalance / Q000209:etiology
chemical_list: D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000451:Mineralocorticoid Receptor Antagonists; D018377:Neurotransmitter Agents; D049994:Sodium Potassium Chloride Symporter Inhibitors