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Aldosterone receptor antagonism induces reverse remodeling when added to angiotensin receptor blockade in chronic heart failure.
J Am Coll Cardiol. 2007 Aug 14; 50(7):591-6.JACC

Abstract

OBJECTIVES

The objective of this study was to determine if adding spironolactone to an angiotensin II receptor blocker improves left ventricular (LV) function, mass, and volumes in chronic heart failure.

BACKGROUND

Add-on spironolactone therapy substantially improves clinical outcomes among patients with severe heart failure (HF) on standard therapy. However, the value of combining spironolactone with an angiotensin II receptor blocker on LV reverse remodeling in mild-to-moderate systolic HF is unclear.

METHODS

Fifty-one systolic HF patients with left ventricular ejection fraction (LVEF) <40% were randomly assigned to receive 1-year treatment of candesartan and spironolactone (combination group) or candesartan and placebo (control group). Reverse remodeling was assessed by serial cardiac magnetic resonance imaging and echocardiographic tissue Doppler imaging (TDI).

RESULTS

There were significant improvements in LVEF (35 +/- 3% vs. 26 +/- 2%, p < 0.01) and reduction of LV end-diastolic volume index (121 +/- 16 ml/m2 vs. 155 +/- 14 ml/m2, p = 0.001), end-systolic volume index (88 +/- 17 ml/m2 vs. 120 +/- 15 ml/m2, p < 0.0005), and LV mass index (81 +/- 6 g/m2 vs. 93 +/- 6 g/m2, p = 0.002) in the combination group at 1 year. In addition, there was significant increase in peak basal systolic velocity and strain by TDI, decrease in index of filling pressure, and increase in cyclic variation integrated backscatter. In the control group, there were no significant changes in all these parameters after 1 year.

CONCLUSIONS

The addition of spironolactone to candesartan has significant beneficial effects on LV reverse remodeling in patients with mild-to-moderate chronic systolic HF.

Authors+Show Affiliations

Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

17692742

Citation

Chan, Anna K Y., et al. "Aldosterone Receptor Antagonism Induces Reverse Remodeling when Added to Angiotensin Receptor Blockade in Chronic Heart Failure." Journal of the American College of Cardiology, vol. 50, no. 7, 2007, pp. 591-6.
Chan AK, Sanderson JE, Wang T, et al. Aldosterone receptor antagonism induces reverse remodeling when added to angiotensin receptor blockade in chronic heart failure. J Am Coll Cardiol. 2007;50(7):591-6.
Chan, A. K., Sanderson, J. E., Wang, T., Lam, W., Yip, G., Wang, M., Lam, Y. Y., Zhang, Y., Yeung, L., Wu, E. B., Chan, W. W., Wong, J. T., So, N., & Yu, C. M. (2007). Aldosterone receptor antagonism induces reverse remodeling when added to angiotensin receptor blockade in chronic heart failure. Journal of the American College of Cardiology, 50(7), 591-6.
Chan AK, et al. Aldosterone Receptor Antagonism Induces Reverse Remodeling when Added to Angiotensin Receptor Blockade in Chronic Heart Failure. J Am Coll Cardiol. 2007 Aug 14;50(7):591-6. PubMed PMID: 17692742.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Aldosterone receptor antagonism induces reverse remodeling when added to angiotensin receptor blockade in chronic heart failure. AU - Chan,Anna K Y, AU - Sanderson,John E, AU - Wang,Tian, AU - Lam,Wynnie, AU - Yip,Gabriel, AU - Wang,Mei, AU - Lam,Yat-Yin, AU - Zhang,Yan, AU - Yeung,Leata, AU - Wu,Eugene B, AU - Chan,Wilson W M, AU - Wong,John T H, AU - So,Nina, AU - Yu,Cheuk-Man, Y1 - 2007/07/30/ PY - 2007/01/24/received PY - 2007/03/09/revised PY - 2007/03/12/accepted PY - 2007/8/19/pubmed PY - 2007/9/29/medline PY - 2007/8/19/entrez SP - 591 EP - 6 JF - Journal of the American College of Cardiology JO - J. Am. Coll. Cardiol. VL - 50 IS - 7 N2 - OBJECTIVES: The objective of this study was to determine if adding spironolactone to an angiotensin II receptor blocker improves left ventricular (LV) function, mass, and volumes in chronic heart failure. BACKGROUND: Add-on spironolactone therapy substantially improves clinical outcomes among patients with severe heart failure (HF) on standard therapy. However, the value of combining spironolactone with an angiotensin II receptor blocker on LV reverse remodeling in mild-to-moderate systolic HF is unclear. METHODS: Fifty-one systolic HF patients with left ventricular ejection fraction (LVEF) <40% were randomly assigned to receive 1-year treatment of candesartan and spironolactone (combination group) or candesartan and placebo (control group). Reverse remodeling was assessed by serial cardiac magnetic resonance imaging and echocardiographic tissue Doppler imaging (TDI). RESULTS: There were significant improvements in LVEF (35 +/- 3% vs. 26 +/- 2%, p < 0.01) and reduction of LV end-diastolic volume index (121 +/- 16 ml/m2 vs. 155 +/- 14 ml/m2, p = 0.001), end-systolic volume index (88 +/- 17 ml/m2 vs. 120 +/- 15 ml/m2, p < 0.0005), and LV mass index (81 +/- 6 g/m2 vs. 93 +/- 6 g/m2, p = 0.002) in the combination group at 1 year. In addition, there was significant increase in peak basal systolic velocity and strain by TDI, decrease in index of filling pressure, and increase in cyclic variation integrated backscatter. In the control group, there were no significant changes in all these parameters after 1 year. CONCLUSIONS: The addition of spironolactone to candesartan has significant beneficial effects on LV reverse remodeling in patients with mild-to-moderate chronic systolic HF. SN - 1558-3597 UR - https://www.unboundmedicine.com/medline/citation/17692742/Aldosterone_receptor_antagonism_induces_reverse_remodeling_when_added_to_angiotensin_receptor_blockade_in_chronic_heart_failure_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-1097(07)01704-4 DB - PRIME DP - Unbound Medicine ER -