|
| HOME | SUBSCRIPTIONS | CURRENT ISSUE | PAST ISSUES | CARDIOSOURCE | SEARCH | HELP | FEEDBACK |
|
|
|
|||||||||
|
|||||||||||
|
J Am Coll Cardiol, 2000; 36:838-844 © 2000 by the American College of Cardiology Foundation |
a First Department of Internal Medicine, Shiga University of Medical Science, Tsukinowa, Seta, Otsu, Japan
Manuscript received December 8, 1999; revised manuscript received March 15, 2000, accepted April 26, 2000.
Reprint requests and correspondence: Dr. Takayoshi Tsutamoto, First Department of Internal Medicine, Shiga University of Medical Science Tsukinowa, Seta, Otsu 520-2192, Japan
tutamoto{at}belle.shiga-med.ac.jp
OBJECTIVES
The study evaluated the transcardiac extraction or spillover of aldosterone (ALDO) in normal subjects and in patients with congestive heart failure (CHF).
BACKGROUND
Aldosterone promotes collagen synthesis and structural remodeling of target organs such as the heart. Spironolactone, an ALDO receptor antagonist, has recently been reported to reduce the mortality of patients with CHF; however, the effects of spironolactone on the transcardiac gradient of ALDO have not been clarified.
METHODS
We measured plasma ALDO in the aortic root (AO) and coronary sinus (CS) in normal subjects and 113 consecutive CHF patients and also measured plasma procollagen type III aminoterminal peptide (PIIINP) in CS, a biochemical marker of myocardial fibrosis.
RESULTS
Plasma ALDO was significantly lower in the CS than in the AO in normal subjects (n = 15; 61.2 ± 9.3 vs. 83.1 ± 11.8 pg/ml, p < 0.0001). In 96 CHF patients who did not receive spironolactone, plasma ALDO was significantly lower in the CS than in the AO (59.3 ± 3.9 vs. 73.8 ± 4.9 pg/ml, p < 0.0001). In contrast to the difference in these 96 patients, there was no significant difference in ALDO between the AO and CS in 17 patients who received spironolactone (127.4 ± 20 vs. 124.0 ± 19 pg/ml, p = 0.50). Stepwise multivariate analyses showed that spironolactone therapy had an independent and significant negative relationship with the transcardiac gradient of plasma ALDO in patients with CHF. In addition, significant positive correlations were seen between the transcardiac gradient of plasma ALDO and PIIINP (r = 0.565, p < 0.0001) and the left ventricular end-diastolic volume index (r = 0.484, p < 0.0001).
CONCLUSIONS
These results indicate that plasma ALDO is extracted through the heart in normal subjects and in CHF patients who do not receive spironolactone and that spironolactone inhibits the transcardiac extraction of ALDO in CHF patients, suggesting that spironolactone blocks the effects of ALDO on the failing heart in patients with CHF.
| ||||||||||||||||||||||||
This article has been cited by other articles:
|
|
 |
|
  S. Kasama, T. Toyama, H. Sumino, H. Kumakura, Y. Takayama, S. Ichikawa, T. Suzuki, and M. Kurabayashi Long-Term Nicorandil Therapy Improves Cardiac Sympathetic Nerve Activity After Reperfusion Therapy in Patients with First Acute Myocardial Infarction J. Nucl. Med., October 1, 2007; 48(10): 1676 - 1682. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Ohtani, M. Ohta, K. Yamamoto, T. Mano, Y. Sakata, M. Nishio, Y. Takeda, J. Yoshida, T. Miwa, M. Okamoto, et al. Elevated cardiac tissue level of aldosterone and mineralocorticoid receptor in diastolic heart failure: beneficial effects of mineralocorticoid receptor blocker Am J Physiol Regulatory Integrative Comp Physiol, February 1, 2007; 292(2): R946 - R954. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Tsutamoto, H. Sakai, A. Wada, C. Ishikawa, K. Ohno, M. Fujii, T. Yamamoto, T. Takayama, T. Dohke, and M. Horie Torasemide inhibits transcardiac extraction of aldosterone in patients with congestive heart failure J. Am. Coll. Cardiol., December 7, 2004; 44(11): 2252 - 2253. [Full Text] [PDF]
|
|
|
|
 |
|
 J. W. Funder Cardiac Synthesis of Aldosterone: Going, Going, Gone... ? Endocrinology, November 1, 2004; 145(11): 4793 - 4795. [Full Text] [PDF]
|
|
|
|
|
|
E. P. Gomez-Sanchez, N. Ahmad, D. G. Romero, and C. E. Gomez-Sanchez Origin of Aldosterone in the Rat Heart Endocrinology, November 1, 2004; 145(11): 4796 - 4802. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Fletcher, A. N. Buch, H. C. Routledge, S. Chowdhary, J. H. Coote, and J. N. Townend Acute aldosterone antagonism improves cardiac vagal control in humans J. Am. Coll. Cardiol., April 7, 2004; 43(7): 1270 - 1275. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. K Shieh, E. Kotlyar, and F. Sam Aldosterone and cardiovascular remodelling: focus on myocardial failure Journal of Renin-Angiotensin-Aldosterone System, March 1, 2004; 5(1): 3 - 13. [Abstract] [PDF]
|
|
|
|
|
|
S. D. Solomon and M. A. Pfeffer Aldosterone antagonism and myocardial infarction: From animals to man and back J. Am. Coll. Cardiol., November 5, 2003; 42(9): 1674 - 1676. [Full Text] [PDF]
|
|
|
|
|
|
K. T Weber, Yao Sun, L. A Wodi, A. Munir, E. Jahangir, R. A Ahokas, I. C Gerling, A. E Postlethwaite, and K. J Warrington Toward a broader understanding of aldosterone in congestive heart failure Journal of Renin-Angiotensin-Aldosterone System, September 1, 2003; 4(3): 155 - 163. [Abstract] [PDF]
|
|
|
|
 |
|
 P. C. White Aldosterone: Direct Effects on and Production by the Heart J. Clin. Endocrinol. Metab., June 1, 2003; 88(6): 2376 - 2383. [Full Text] [PDF]
|
|
|
|
 |
|
 M. Hayashi, T. Tsutamoto, A. Wada, T. Tsutsui, C. Ishii, K. Ohno, M. Fujii, A. Taniguchi, T. Hamatani, Y. Nozato, et al. Immediate Administration of Mineralocorticoid Receptor Antagonist Spironolactone Prevents Post-Infarct Left Ventricular Remodeling Associated With Suppression of a Marker of Myocardial Collagen Synthesis in Patients With First Anterior Acute Myocardial Infarction Circulation, May 27, 2003; 107(20): 2559 - 2565. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Yoshimura, S. Nakamura, T. Ito, M. Nakayama, E. Harada, Y. Mizuno, T. Sakamoto, M. Yamamuro, Y. Saito, K. Nakao, et al. Expression of Aldosterone Synthase Gene in Failing Human Heart: Quantitative Analysis Using Modified Real-Time Polymerase Chain Reaction J. Clin. Endocrinol. Metab., August 1, 2002; 87(8): 3936 - 3940. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. P. Rossi, V. Di Bello, C. Ganzaroli, A. Sacchetto, M. Cesari, A. Bertini, D. Giorgi, R. Scognamiglio, M. Mariani, and A. C. Pessina Excess ldosterone Is Associated With Alterations of Myocardial Texture in Primary Aldosteronism Hypertension, July 1, 2002; 40(1): 23 - 27. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Hayashi, T. Tsutamoto, A. Wada, K. Maeda, N. Mabuchi, T. Tsutsui, T. Matsui, M. Fujii, T. Matsumoto, T. Yamamoto, et al. Relationship between transcardiac extraction of aldosterone and left ventricular remodeling in patients with first acute myocardial infarction: extracting aldosterone through the heart promotes ventricular remodeling after acute myocardial infarction J. Am. Coll. Cardiol., November 1, 2001; 38(5): 1375 - 1382. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. E. Gomez-Sanchez and E. P. Gomez-Sanchez Cardiac Steroidogenesis--New Sites of Synthesis, or Much Ado About Nothing? J. Clin. Endocrinol. Metab., November 1, 2001; 86(11): 5118 - 5120. [Full Text] [PDF]
|
|
|
|
|
|
M. Hayashi, T. Tsutamoto, A. Wada, K. Maeda, N. Mabuchi, T. Tsutsui, H. Horie, M. Ohnishi, and M. Kinoshita Intravenous atrial natriuretic peptide prevents left ventricular remodeling in patients with first anterior acute myocardial infarction J. Am. Coll. Cardiol., June 1, 2001; 37(7): 1820 - 1826. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Tsutamoto, A. Wada, K. Maeda, N. Mabuchi, M. Hayashi, T. Tsutsui, M. Ohnishi, M. Sawaki, M. Fujii, T. Matsumoto, et al. Effect of spironolactone on plasma brain natriuretic peptide and left ventricular remodeling in patients with congestive heart failure J. Am. Coll. Cardiol., April 1, 2001; 37(5): 1228 - 1233. [Abstract] [Full Text] [PDF]
|
|
| HOME | SUBSCRIPTIONS | CURRENT ISSUE | PAST ISSUES | CARDIOSOURCE | SEARCH | HELP | FEEDBACK |
