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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.

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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