Effects of spironolactone treatment in elderly women with heart failure and
preserved left ventricular ejection fraction.
Author(s): Kurrelmeyer KM(1), Ashton Y(2), Xu J(2), Nagueh SF(3), Torre-Amione G(3), Deswal
A(4).
Affiliation(s): Author information:
(1)Methodist DeBakey Heart and Vascular Center, Department of Cardiology,
Houston, Texas. Electronic address: kkurrelmeyer@houstonmethodist.org. (2)Houston
Hospital Research Institute, Houston, Texas. (3)Methodist DeBakey Heart and
Vascular Center, Department of Cardiology, Houston, Texas. (4)Michael E. DeBakey
VA Medical Center and Baylor College of Medicine, Department of Cardiology,
Houston, Texas.
Publication date & source: 2014, J Card Fail. , 20(8):560-8
BACKGROUND: Although spironolactone has been shown to decrease morbidity and
mortality in patients with heart failure and reduced left ventricular ejection
fraction, its role in patients with heart failure and preserved left ventricular
ejection fraction (HFpEF) is not well defined. In this study we investigated the
mechanisms involved when elderly women with HFpEF are treated with
spironolactone.
METHODS AND RESULTS: Forty-eight women with HFpEF were enrolled in a randomized
placebo-controlled trial and were assigned to 25 mg spironolactone daily (n = 24)
or placebo (n = 24) for 6 months. Six-minute walk distance, clinical composite
score, Doppler echocardiography, and biomarkers were determined at baseline and
after 3 and 6 months of therapy. Six months of spironolactone treatment
stabilized clinical symptoms, as demonstrated by significant worsening of the
clinical composite score in the placebo group (P = .02). In addition,
spironolactone treatment improved diastolic function by significantly increasing
early diastolic tissue Doppler velocity of the lateral mitral annulus (lateral
e'; P = .003) and significantly reducing the mitral peak E velocity to lateral e'
ratio (lateral E/e'; P = .0001). Finally, spironolactone favorably affected
remodeling through a reduction in myocardial fibrosis measured by a reduction in
type III procollagen levels (P = .035). Six-minute walk distance did not
significantly improve with spironolactone treatment compared with placebo.
CONCLUSIONS: Spironolactone stabilizes functional capacity and symptoms and
improves diastolic function, possibly through its ability to suppress type III
procollagen synthesis.
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