Background: The activation of renin-angiotensin-aldosterone systems plays a key role in the development of myocardial hypertrophy and fibrosis. However, ACE inhibitors can't inhibit the left ventricular (LV) remodeling sufficiently, which may be related with ‘aldosterone escape’ phenomenon. The use of aldosterone antagonists may have additional benefits in LV structural parameters improving.
Aim: To evaluate the effects of spironolactone (SPRL) on LV hypertrophy in patients with chronic heart failure (CHF) with preserved ejection fraction (EF).
Methods: We observed 79 patients (48 men and 31 women, mean age 54.5 ± 10.5 years) with stable coronary arterial disease (CAD) and mild CHF (no higher II functional class (NYHA)) with preserved systolic function of the LV (EF > 45%). The patients were randomly divided into 2 groups: SPRL group was treated with the standard therapy (ACE inhibitors or angiotensin receptor blockers II, β-blockers, statins, antiplatelet agents) plus SPRL (25 mg/day, titrated to 50 mg/day if tolerated) and control group was treated with standard therapy only for the next 6 months. Transthoracic echocardiography (TTE) for all patients at baseline and after 6 months was performed. The LV posterior wall thickness (LVPWT), intraventricular septal thickness (IVST), relative wall thickness (RWT) and LV mass index (LVMI) were determined. Patients were classified into 4 subgroups of LV geometric pattern according to the LVMI and RWT.
Results: At baseline there were no significant differences between two groups (p > 0,05). After 6 month both groups significantly reduced the IVST compared with the initial data, but it was strongly expressed in the SPRL group (p = 0.012). There were no significant changes in parameters of LVPWT and RWT in both groups (p > 0.05). The addition of SPRL treatment significantly reduced the number of patients with concentric LV hypertrophy - from 22 (55%) to 7 (17,5%) (χ2=10.6, p = 0.001) and increased the number of patient with normal geometry - from 2 (5%) to 11 (27.5%) (χ2=5.88, p = 0.015); however, it didn't significant improve the eccentric LV hypertrophy (p = 0.653). The patients with concentric remodeling have appeared in SPRL group - 7,5%. There were no significant improvement in the LV geometric pattern in control group (p > 0,05).
Conclusions: These results indicated that the addition of SPRL to the standard treatment is clinically useful to improve the LV geometric pattern and reduce the LV hypertrophy in patients with stable CAD and mild CHF with preserved EF.