OBJECTIVES: We sought to evaluate the effects of spironolactone on neurohumoral factors and left ventricular remodeling in patients with congestive heart failure (CHF). BACKGROUND:Aldosterone (ALD) promotes collagen synthesis and structural remodeling of the heart. Spironolactone, an ALD receptor antagonist, is reported to reduce mortality in patients with CHF, but its influence on left ventricular remodeling has not been clarified. METHODS:Thirty-seven patients with mild-to-moderate nonischemic CHF were randomly divided into two groups that received treatment with spironolactone (n = 20) or placebo (n = 17). We measured left ventricular volume and mass before treatment and after four months of treatment. We also measured the plasma levels of neurohumoral factors, such as atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP), as well as plasma procollagen type III aminoterminal peptide (PIIINP), a marker of myocardial fibrosis. RESULTS:Left ventricular volume and mass were significantly decreased and ejection fraction was significantly increased in the spironolactone group, while there were no changes in the placebo group. Plasma levels of ANP, BNP and PIIINP were significantly decreased after spironolactone treatment, but were unchanged in the placebo group. There was a significant positive correlation between the changes of PIIINP and changes of the left ventricular volume index (r = 0.45, p = 0.045) as well as the left ventricular mass index (r = 0.65, p = 0.0019) with spironolactone treatment. CONCLUSIONS: These findings indicate that four months of treatment with spironolactone improved the left ventricular volume and mass, as well as decreased plasma level of BNP, a biochemical marker of prognosis and/or ventricular hypertrophy, suggesting that endogenous aldosterone has an important role in the process of left ventricular remodeling in nonischemic patients with CHF.
RCT Entities:
OBJECTIVES: We sought to evaluate the effects of spironolactone on neurohumoral factors and left ventricular remodeling in patients with congestive heart failure (CHF). BACKGROUND:Aldosterone (ALD) promotes collagen synthesis and structural remodeling of the heart. Spironolactone, an ALD receptor antagonist, is reported to reduce mortality in patients with CHF, but its influence on left ventricular remodeling has not been clarified. METHODS: Thirty-seven patients with mild-to-moderate nonischemic CHF were randomly divided into two groups that received treatment with spironolactone (n = 20) or placebo (n = 17). We measured left ventricular volume and mass before treatment and after four months of treatment. We also measured the plasma levels of neurohumoral factors, such as atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP), as well as plasma procollagen type III aminoterminal peptide (PIIINP), a marker of myocardial fibrosis. RESULTS: Left ventricular volume and mass were significantly decreased and ejection fraction was significantly increased in the spironolactone group, while there were no changes in the placebo group. Plasma levels of ANP, BNP and PIIINP were significantly decreased after spironolactone treatment, but were unchanged in the placebo group. There was a significant positive correlation between the changes of PIIINP and changes of the left ventricular volume index (r = 0.45, p = 0.045) as well as the left ventricular mass index (r = 0.65, p = 0.0019) with spironolactone treatment. CONCLUSIONS: These findings indicate that four months of treatment with spironolactone improved the left ventricular volume and mass, as well as decreased plasma level of BNP, a biochemical marker of prognosis and/or ventricular hypertrophy, suggesting that endogenous aldosterone has an important role in the process of left ventricular remodeling in nonischemic patients with CHF.
Authors: Jonathan Buggey; Robert J Mentz; Bertram Pitt; Eric L Eisenstein; Kevin J Anstrom; Eric J Velazquez; Christopher M O'Connor Journal: Am Heart J Date: 2015-01-06 Impact factor: 4.749
Authors: Lutz Frankenstein; Svenja Seide; Tobias Täger; Katrin Jensen; Hanna Fröhlich; Andrew L Clark; Mirjam Seiz; Hugo A Katus; Paul Nee; Lorenz Uhlmann; Huseyin Naci; Dan Atar Journal: Heart Fail Rev Date: 2020-03 Impact factor: 4.214
Authors: Catherine N Marti; Gregg C Fonarow; Stefan D Anker; Clyde Yancy; Muthiah Vaduganathan; Stephen J Greene; Ali Ahmed; James L Januzzi; Mihai Gheorghiade; Gerasimos Filippatos; Javed Butler Journal: Eur J Heart Fail Date: 2018-12-10 Impact factor: 15.534
Authors: Solomon K Musani; Ervin R Fox; Aldi Kraja; Aurelian Bidulescu; Wolfgang Lieb; Honghuang Lin; Ashley Beecham; Ming-Huei Chen; Janine F Felix; Caroline S Fox; W H Linda Kao; Sharon L R Kardia; Ching-Ti Liu; Mike A Nalls; Tatjana Rundek; Ralph L Sacco; Jennifer Smith; Yan V Sun; Gregory Wilson; Zhaogong Zhang; Thomas H Mosley; Herman A Taylor; Ramachandran S Vasan Journal: Circ Cardiovasc Genet Date: 2015-01-05
Authors: William S Bradham; Susan P Bell; Douglas W Adkisson; Holly M Smith; Frank E Harrell; Mark A Lawson; Henry Ooi; Douglas B Sawyer; Marvin W Kronenberg Journal: J Card Fail Date: 2016-12-08 Impact factor: 5.712