CLINICAL STUDY: HEART FAILURE
Effect of spironolactone on cardiacsympathetic nerve activity and left ventricular remodeling in patients with dilated cardiomyopathy
Shu Kasama, MD*,*,
Takuji Toyama, MD*,
Hisao Kumakura, MD ,
Yoshiaki Takayama, MD,
Shuichi Ichikawa, MD,
Tadashi Suzuki, MD* and
Masahiko Kurabayashi, MD*
* Second Department of Internal Medicine, Gunma University School of Medicine, MaebashiJapan
Kitakanto Cardiovascular Hospital, Gunma, Japan
Manuscript received July 10, 2002;
revised manuscript received October 17, 2002,
accepted October 31, 2002.
* Reprint requests and correspondence: Dr. Shu Kasama, Second Department of Internal Medicine, Gunma University School of Medicine, 3-39-15, Showa-machi, Maebashi, Gunma 371-0034, Japan.
s-kasama{at}bay.wind.ne.jp
OBJECTIVES: We sought to evaluate the effects of spironolactone on cardiac sympathetic nerve activity and left ventricular (LV) remodeling in patients with dilated cardiomyopathy (DCM).
BACKGROUND: Aldosterone prevents the uptake of norepinephrine and promotes structural remodeling of the heart. Spironolactone, an aldosterone receptor blocker, improves LV remodeling in patients with DCM, but its influence on cardiac sympathetic nerve activity has not been determined.
METHODS: We selected 30 patients with DCM who were treated with an angiotensin-converting enzyme inhibitor and a loop diuretic. Fifteen patients were assigned to receive spironolactone additionally, whereas the remaining 15 patients continued their current regimen. The delayed heart/mediastinum (H/M) count ratio, delayed total defect score (TDS), and washout rate (WR) were determined from iodine-123 (123I)-meta-iodobenzylguanidine (MIBG) images before and six months after treatment. The left ventricular end-diastolic volume (LVEDV) and left ventricular ejection fraction (LVEF) were determined by echocardiography, and New York Heart Association (NYHA) functional class was estimated.
RESULTS: In the spironolactone group, the TDS decreased from 36 ± 9 to 24 ± 13 (p < 0.0001), the H/M ratio increased from 1.64 ± 0.20 to 1.86 ± 0.27 (p < 0.0001), and WR decreased from 55 ± 12% to 41 ± 15% (p < 0.0005). In addition, the LVEDV decreased from 187 ± 26 to 154 ± 41 ml (p < 0.005), and LVEF increased from 33 ± 6% to 39 ± 6% (p < 0.005). However, there were no significant changes in these parameters in the control group. There was a significant correlation between changes in the 123I-MIBG findings and changes in LVEDV with spironolactone treatment (TDS: r = 0.684, p = 0.0038; H/M ratio: r = –0.878, p < 0.0001; and WR: r = 0.737, p = 0.0011). The NYHA functional class improved in both groups but showed a greater improvement in the spironolactone group than in the control group (p < 0.01).
CONCLUSIONS: Spironolactone improves cardiac sympathetic nerve activity and LV remodeling in patients with DCM.
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Abbreviations and Acronyms
| | ACE | | angiotensin-converting enzyme | | CHF | | congestive heart failure | | DCM | | dilated cardiomyopathy | | H/M | | heart/mediastinum count | | LV | | left ventricular | | LVEDV | | left ventricular end-diastolic volume | | LVEF | | left ventricular ejection fraction | | MIBG | | meta-iodobenzylguanidine | | NYHA | | New York Heart Association | | SPECT | | single-photon emission computed tomography | | TDS | | total defect score | | WR | | washout rate |
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