Abstract 20031: Effects of Spironolactone in Women with Heart Failure and Preserved Left-Ventricular Ejection Fraction
Background: Although spironolactone has been shown to decrease morbidity and mortality in patients with systolic heart failure, it's role in diastolic heart failure (DHF) is unclear. We sought to investigate whether spironolactone would improve exercise tolerance, symptoms, echocardiography measurements of diastolic function, and biomarkers in women with DHF.
Methods: Forty-eight women on chronic ACEI or ARB therapy with DHF defined as NYHA class II or III heart failure, LVEF > 50%, elevated filling pressures by Doppler echocardiography, and BNP >62 were randomly assigned to spironolactone 25 mg daily (n=24) or placebo (n=24) for 6 months. The primary outcome was change in six minute walk distance after 6 months of therapy. Secondary outcomes included changes in clinical composite score, echocardiography Doppler measurements of diastolic function, and the following biomarkers: BNP, N-terminal of type I and III procollagen (PINP, PIIINP), and c-terminal of type I collagen (ICTP) after 6 months of therapy.
Results: The patients had a mean age of 70 years, more than 80% had chronic hypertension, and the majority were in NYHA class III with prior hospitalizations for DHF. Exercise tolerance was severely impaired in both groups. Six months of spironolactone treatment did not improve 6 minute walk distance when compared to placebo. However, the clinical composite score significantly worsened in the placebo group when compared to the spironolactone group (p=0.02). In addition, spironolactone treatment resulted in a significant increase in the tissue Doppler velocity of the lateral mitral annulus (e′) (p=0.003) and a significant reduction in the mitral peak E velocity to e′ ratio (E/e′) (p=0.0001). Also, PIIINP levels decreased significantly with spironolactone therapy (p=0.035). Spironolactone treatment did not effect the other biomarkers.
Conclusions: Spironolactone does not improve exercise tolerance in an elderly patient population with multiple co-morbities that may effect mobility. However,spironolactone stabilizes symptoms and improves echocardiography diastolic indices possibly through its ability to suppress type III procollagen synthesis.
- © 2010 by American Heart Association, Inc.