Abstract 17385: Eplerenon Reduces Qtc Time Intervall in Primary Hyperparathyroidism
Purpose: Clinical and experimental studies indicated that mineralocorticoid receptor (MR) antagonism may affect cardiovascular risk in patients with primary hyperparathyroidism (pHPT). We therefore aimed to test in a randomized, placebo-controlled trial whether the MR-antagonist eplerenone reduced standard 12-lead ECG derived QTc time in patients with pHPT.
Methods: The present study analyzed the post-specified endpoint of change in QTc time of the “Effect of Eplerenone on Parathyroid Hormone Levels in Patients with Primary Hyperparathyroidism” (EPATH) Trial (ISCRN 33941607). Patients with primary hyperparathyroidism (n=110), were randomly 1:1 assigned to treatment with 25mg eplerenone (escalation to 50mg after four weeks) or matching placebo for 8 weeks. An analysis of covariance was performed to test the interaction between treatment with eplerenone and QTc time, adjusting for QRS duration and heart rate.
Results: The trial was completed by 97 (88.2%) participants (mean age 67.5±9.5years, 78.4% females). Median PTH was 102 (83 - 127) pg/mL, mean ionized calcium was 2.62 ± 0.14 mmol/L and median QTc was 418 (IQR: 402.75-432.25) msec. In analysis of covariance eplerenone had a mean treatment effect on QTc of -6.72 (95%CI: -12.37 to -0.70) msec, P=0.029.
Conclusions: MR antagonism for 8 weeks significantly reduced the QTc time in patients with pHPT. The mechanism might be related to anti-fibrotic and reverse remodeling. These data confirm evidence from basic science and raise awareness of a possible role of eplerenone treatment in cardiac and especially arrhythmic risk reduction in patients with PTH excess.
Author Disclosures: M.R. Grubler: None. N. Verheyen: None. J. Schmid: None. A. Fahrleitner-Pammer: None. C. Catena: None. A. Meinitzer: None. H. Brussee: None. W. März: None. B. Pieske: Research Grant; Significant; Daiichi-Sanyo, Bayer Healthcare, Novartis, Stealth Peptides, Servier, Abboatt Vascular, Astra-Zeneca, Stealth Peptides Board membership. S. Pilz: None. A. Tomaschitz: None.
- © 2016 by American Heart Association, Inc.