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Effects of spironolactone treatment in elderly women with heart failure and preserved left ventricular ejection fraction.
J Card Fail. 2014 Aug; 20(8):560-8.JC

Abstract

BACKGROUND

Although spironolactone has been shown to decrease morbidity and mortality in patients with heart failure and reduced left ventricular ejection fraction, its role in patients with heart failure and preserved left ventricular ejection fraction (HFpEF) is not well defined. In this study we investigated the mechanisms involved when elderly women with HFpEF are treated with spironolactone.

METHODS AND RESULTS

Forty-eight women with HFpEF were enrolled in a randomized placebo-controlled trial and were assigned to 25 mg spironolactone daily (n = 24) or placebo (n = 24) for 6 months. Six-minute walk distance, clinical composite score, Doppler echocardiography, and biomarkers were determined at baseline and after 3 and 6 months of therapy. Six months of spironolactone treatment stabilized clinical symptoms, as demonstrated by significant worsening of the clinical composite score in the placebo group (P = .02). In addition, spironolactone treatment improved diastolic function by significantly increasing early diastolic tissue Doppler velocity of the lateral mitral annulus (lateral e'; P = .003) and significantly reducing the mitral peak E velocity to lateral e' ratio (lateral E/e'; P = .0001). Finally, spironolactone favorably affected remodeling through a reduction in myocardial fibrosis measured by a reduction in type III procollagen levels (P = .035). Six-minute walk distance did not significantly improve with spironolactone treatment compared with placebo.

CONCLUSIONS

Spironolactone stabilizes functional capacity and symptoms and improves diastolic function, possibly through its ability to suppress type III procollagen synthesis.

Authors+Show Affiliations

Methodist DeBakey Heart and Vascular Center, Department of Cardiology, Houston, Texas. Electronic address: kkurrelmeyer@houstonmethodist.org.Houston Hospital Research Institute, Houston, Texas.Houston Hospital Research Institute, Houston, Texas.Methodist DeBakey Heart and Vascular Center, Department of Cardiology, Houston, Texas.Methodist DeBakey Heart and Vascular Center, Department of Cardiology, Houston, Texas.Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Department of Cardiology, Houston, Texas.

Pub Type(s)

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

Language

eng

PubMed ID

24905296

Citation

Kurrelmeyer, Karla M., et al. "Effects of Spironolactone Treatment in Elderly Women With Heart Failure and Preserved Left Ventricular Ejection Fraction." Journal of Cardiac Failure, vol. 20, no. 8, 2014, pp. 560-8.
Kurrelmeyer KM, Ashton Y, Xu J, et al. Effects of spironolactone treatment in elderly women with heart failure and preserved left ventricular ejection fraction. J Card Fail. 2014;20(8):560-8.
Kurrelmeyer, K. M., Ashton, Y., Xu, J., Nagueh, S. F., Torre-Amione, G., & Deswal, A. (2014). Effects of spironolactone treatment in elderly women with heart failure and preserved left ventricular ejection fraction. Journal of Cardiac Failure, 20(8), 560-8. https://doi.org/10.1016/j.cardfail.2014.05.010
Kurrelmeyer KM, et al. Effects of Spironolactone Treatment in Elderly Women With Heart Failure and Preserved Left Ventricular Ejection Fraction. J Card Fail. 2014;20(8):560-8. PubMed PMID: 24905296.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of spironolactone treatment in elderly women with heart failure and preserved left ventricular ejection fraction. AU - Kurrelmeyer,Karla M, AU - Ashton,Yelena, AU - Xu,Jiaqiong, AU - Nagueh,Sherif F, AU - Torre-Amione,Guillermo, AU - Deswal,Anita, Y1 - 2014/06/04/ PY - 2013/12/02/received PY - 2014/05/19/revised PY - 2014/05/23/accepted PY - 2014/6/7/entrez PY - 2014/6/7/pubmed PY - 2015/5/12/medline KW - Heart failure KW - biomarkers KW - clinical trials KW - diastolic function KW - spironolactone SP - 560 EP - 8 JF - Journal of cardiac failure JO - J. Card. Fail. VL - 20 IS - 8 N2 - BACKGROUND: Although spironolactone has been shown to decrease morbidity and mortality in patients with heart failure and reduced left ventricular ejection fraction, its role in patients with heart failure and preserved left ventricular ejection fraction (HFpEF) is not well defined. In this study we investigated the mechanisms involved when elderly women with HFpEF are treated with spironolactone. METHODS AND RESULTS: Forty-eight women with HFpEF were enrolled in a randomized placebo-controlled trial and were assigned to 25 mg spironolactone daily (n = 24) or placebo (n = 24) for 6 months. Six-minute walk distance, clinical composite score, Doppler echocardiography, and biomarkers were determined at baseline and after 3 and 6 months of therapy. Six months of spironolactone treatment stabilized clinical symptoms, as demonstrated by significant worsening of the clinical composite score in the placebo group (P = .02). In addition, spironolactone treatment improved diastolic function by significantly increasing early diastolic tissue Doppler velocity of the lateral mitral annulus (lateral e'; P = .003) and significantly reducing the mitral peak E velocity to lateral e' ratio (lateral E/e'; P = .0001). Finally, spironolactone favorably affected remodeling through a reduction in myocardial fibrosis measured by a reduction in type III procollagen levels (P = .035). Six-minute walk distance did not significantly improve with spironolactone treatment compared with placebo. CONCLUSIONS: Spironolactone stabilizes functional capacity and symptoms and improves diastolic function, possibly through its ability to suppress type III procollagen synthesis. SN - 1532-8414 UR - https://www.unboundmedicine.com/medline/citation/24905296/Effects_of_spironolactone_treatment_in_elderly_women_with_heart_failure_and_preserved_left_ventricular_ejection_fraction_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1071-9164(14)00215-2 DB - PRIME DP - Unbound Medicine ER -