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Long-term, dose-dependent effects of spironolactone on left ventricular function and exercise tolerance in patients with chronic heart failure.
J Am Coll Cardiol. 2002 Jul 17; 40(2):304-10.JACC

Abstract

OBJECTIVES

This study was designed to assess the effects of spironolactone (SP) on left ventricular (LV) function and exercise tolerance in patients with chronic heart failure (CHF).

BACKGROUND

In severe heart failure (HF), SP improves survival, but the underlying mechanisms are not clear.

METHODS

We randomized 106 outpatients with HF to SP (12.5 to 50 mg/day) (group 1) or control (group 2). Complete echocardiography and cardiopulmonary exercise testing were performed at baseline and 12 months after randomization.

RESULTS

Left ventricular end-systolic volume at baseline and at follow-up was 188 +/- 94 ml and 171 +/- 97 ml in group 1 and 173 +/- 71 ml and 168 +/- 79 ml in group 2 (treatment group-by-time interaction, p = 0.03). Left ventricular ejection fraction at baseline and at follow-up was 33 +/- 7% and 36 +/- 9% in group 1 and 34 +/- 7% and 34 +/- 9% in group 2 (treatment group-by-time interaction, p = 0.02). At baseline, 9 patients in group 1 and 3 patients in group 2 had a restrictive mitral filling pattern, a marker of severe diastolic dysfunction; at follow-up, 3 patients in group 1 and no patient in group 2 improved their pattern. No patient in group 1 and 4 patients in group 2 worsened their pattern (chi-square, p = 0.02). Peak oxygen consumption increased significantly in patients treated with 50 mg of SP and decreased in group 2 (17.7 +/- 5.2 vs. 18.5 +/- 5.9 and 19.1 +/- 5.6 vs. 17.9 +/- 5.3, respectively; analysis of variance, p = 0.01).

CONCLUSIONS

Spironolactone improves LV volumes and function; furthermore, it improves exercise tolerance at the highest administered dose. Our data might explain the mortality reduction during aldosterone antagonism in patients with HF.

Authors+Show Affiliations

Dipartimento di Scienze Biomediche e Chirurgiche, Sezione di Cardiologia Università degli Studi di Verona, P. Le Stefani, I-37126 Verona, Italy. mariantoinetta.cicoira@univr.itNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

12106936

Citation

Cicoira, Mariantonietta, et al. "Long-term, Dose-dependent Effects of Spironolactone On Left Ventricular Function and Exercise Tolerance in Patients With Chronic Heart Failure." Journal of the American College of Cardiology, vol. 40, no. 2, 2002, pp. 304-10.
Cicoira M, Zanolla L, Rossi A, et al. Long-term, dose-dependent effects of spironolactone on left ventricular function and exercise tolerance in patients with chronic heart failure. J Am Coll Cardiol. 2002;40(2):304-10.
Cicoira, M., Zanolla, L., Rossi, A., Golia, G., Franceschini, L., Brighetti, G., Marino, P., & Zardini, P. (2002). Long-term, dose-dependent effects of spironolactone on left ventricular function and exercise tolerance in patients with chronic heart failure. Journal of the American College of Cardiology, 40(2), 304-10.
Cicoira M, et al. Long-term, Dose-dependent Effects of Spironolactone On Left Ventricular Function and Exercise Tolerance in Patients With Chronic Heart Failure. J Am Coll Cardiol. 2002 Jul 17;40(2):304-10. PubMed PMID: 12106936.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-term, dose-dependent effects of spironolactone on left ventricular function and exercise tolerance in patients with chronic heart failure. AU - Cicoira,Mariantonietta, AU - Zanolla,Luisa, AU - Rossi,Andrea, AU - Golia,Giorgio, AU - Franceschini,Lorenzo, AU - Brighetti,Giovanna, AU - Marino,Paolo, AU - Zardini,Piero, PY - 2002/7/11/pubmed PY - 2002/7/27/medline PY - 2002/7/11/entrez SP - 304 EP - 10 JF - Journal of the American College of Cardiology JO - J. Am. Coll. Cardiol. VL - 40 IS - 2 N2 - OBJECTIVES: This study was designed to assess the effects of spironolactone (SP) on left ventricular (LV) function and exercise tolerance in patients with chronic heart failure (CHF). BACKGROUND: In severe heart failure (HF), SP improves survival, but the underlying mechanisms are not clear. METHODS: We randomized 106 outpatients with HF to SP (12.5 to 50 mg/day) (group 1) or control (group 2). Complete echocardiography and cardiopulmonary exercise testing were performed at baseline and 12 months after randomization. RESULTS: Left ventricular end-systolic volume at baseline and at follow-up was 188 +/- 94 ml and 171 +/- 97 ml in group 1 and 173 +/- 71 ml and 168 +/- 79 ml in group 2 (treatment group-by-time interaction, p = 0.03). Left ventricular ejection fraction at baseline and at follow-up was 33 +/- 7% and 36 +/- 9% in group 1 and 34 +/- 7% and 34 +/- 9% in group 2 (treatment group-by-time interaction, p = 0.02). At baseline, 9 patients in group 1 and 3 patients in group 2 had a restrictive mitral filling pattern, a marker of severe diastolic dysfunction; at follow-up, 3 patients in group 1 and no patient in group 2 improved their pattern. No patient in group 1 and 4 patients in group 2 worsened their pattern (chi-square, p = 0.02). Peak oxygen consumption increased significantly in patients treated with 50 mg of SP and decreased in group 2 (17.7 +/- 5.2 vs. 18.5 +/- 5.9 and 19.1 +/- 5.6 vs. 17.9 +/- 5.3, respectively; analysis of variance, p = 0.01). CONCLUSIONS: Spironolactone improves LV volumes and function; furthermore, it improves exercise tolerance at the highest administered dose. Our data might explain the mortality reduction during aldosterone antagonism in patients with HF. SN - 0735-1097 UR - https://www.unboundmedicine.com/medline/citation/12106936/Long_term_dose_dependent_effects_of_spironolactone_on_left_ventricular_function_and_exercise_tolerance_in_patients_with_chronic_heart_failure_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735109702019654 DB - PRIME DP - Unbound Medicine ER -