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Abstract: FR-PO1026

Magnetic Resonance Imaging Evaluation of Mineralocorticoid Receptor Antagonism in Diabetic Atherosclerosis (MAGMA) Trial: Baseline Characteristics

Session Information

Category: Hypertension and CVD

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

  • Sarode, Anuja, University Hospitals, Kent, Ohio, United States
  • Fares, Anas, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States
  • Conger, Heather L., University Hospitals, Kent, Ohio, United States
  • Connelly, Kim, St Michael's Hospital, Toronto, Ontario, Canada
  • Dever, Ann M., University Hospitals Cleveland, Cleveland, Ohio, United States
  • Gaztanaga, Juan, NYU Winthrop Hospital, Mineola, New York, United States
  • Razavi nematollahi, Laleh, University Hospitals of Cleveland, Orange, Iran (the Islamic Republic of)
  • Vergara-Martel, Armando, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States
  • Weir, Matthew R., University of Maryland School of Medicine, Baltimore, Maryland, United States
  • Rajagopalan, Sanjay, University Hospitals, Kent, Ohio, United States
  • Dobre, Mirela A., Case Western Reserve University, Cleveland, Ohio, United States
Background

MAGMA is a multicenter double-blind, randomized controlled trial that aims to assess the effect of spironolactone on atherosclerosis progression and left ventricular (LV) mass regression in type 2 diabetic patients with CKD.

Methods

46 adult diabetic patients with eGFR<90 ml/min/1.73m2 and albuminuria>30 mg/g or eGFR<60 ml/min/1.73m2 regardless of albuminuria, on ACEi/ARB were enrolled at 4 sites and randomly assigned to spironolactone (12.5mg with eventual escalation to 25mg daily) vs. placebo. 24hr ambulatory blood pressure monitoring (ABPM) and cardiac MRI and aortic plaque imaging were performed at baseline and will be repeated at 1 year. We examined baseline characteristics and achieved systolic blood pressure (SBP) at 6 weeks follow-up.

Results

The mean age(SD) was 63(8.3) years; 46% were women, and 52% were African-American. Baseline characteristics showed no significant differences between the groups(Table). Native myocardial T1 times, a marker of myocardial fibrosis, were high normal across groups. At 6 weeks, treatment A group had an increase in average 24hr overall and nocturnal SBP by 3.9(20.8) mmHg and 5.7(25.2) mmHg respectively. Treatment B group had an average decrease in 24hr overall and nocturnal SBP of – 6.0(11.7) mmHg, and – 8.3(9.8) mmHg respectively.

Conclusion

MAGMA trial enrolled individuals with high atherosclerotic disease burden. Long-term follow-up will provide critical insights into the role of mineralocorticoid antagonism on LV mass and atherosclerosis reduction in high-risk patients.

History of atherosclerotic diseaseTreatment A (n= 21 )Treatment B (n=25)
≥3 Antihypertensive medications11 (52)10 (40)
Statins14 (66)15 (60)
eGFR (mL/min/1.73m2)20 (95)23 (96)
eGFR (mL/min/1.73m2)46.3 ± 19.950.5 ± 17.8
Urine Albumin/Creatinine (mg/g)291.8 ± 461.9139.8 ± 173.5
Hemoglobin A1C(%)7.4 ±1.27.2 ±1.2
Potassium (mmol/L)4.2 ± 0.54.1 ± 0.4
24hr ABPM SBP (mmHg)136.8 ± 14.1138.3 ± 15.0
Asleep SBP (mmHg)129.8 ± 22.5133.2 ± 17.8
Global native T1 myocardial time (ms)1209.8 ± 41.91186.4 ± 40.9
LV mass index (g/m2)64.54 ± 20.964.3 ± 11.0
LV ejection fraction (%)57.3 ± 13.962.4 ± 10.4

Values represent mean±SD or number(%)

Funding

  • Other NIH Support