Document Detail

Antifailure therapy including spironolactone improves left ventricular energy supply-demand relations in nonischemic dilated cardiomyopathy.
MedLine Citation:
PMID:  25164945     Owner:  NLM     Status:  In-Data-Review    
BACKGROUND: Left ventricular (LV) energy supply-demand imbalance is postulated to cause "energy starvation" and contribute to heart failure (HF) in nonischemic dilated cardiomyopathy (NIDCM). Using cardiac magnetic resonance (CMR) and [(11)C] acetate positron emission tomography (PET), we evaluated LV perfusion and oxidative metabolism in NIDCM and the effects of spironolactone on LV supply-demand relations.
METHODS AND RESULTS: Twelve patients with NIDCM underwent CMR and PET at baseline and after ≥6 months of spironolactone therapy added to a standard HF regimen. The myocardial perfusion reserve index (MPRI) was calculated after gadolinium injection during adenosine, as compared to rest. The monoexponential clearance rate of [(11)C] acetate (kmono) was used to calculate the work metabolic index (WMI), an index of LV mechanical efficiency, and kmono/RPP (rate-pressure product), an index of energy supply/demand. At baseline, the subendocardium was hypoperfused versus the subepicardium (median MPRI, 1.63 vs. 1.80; P<0.001), but improved to 1.80 (P<0.001) after spironolactone. The WMI increased (P=0.001), as did kmono/RPP (P=0.003). These improvements were associated with reverse remodeling, increased LV ejection fraction, and decreases in LV mass and systolic wall stress (all P<0.002).
CONCLUSIONS: NIDCM is associated with subendocardial hypoperfusion and impaired myocardial oxidative metabolism, consistent with energy starvation. Antifailure therapy improves parameters of energy starvation and is associated with augmented LV performance.
Susan P Bell; Douglas W Adkisson; Mark A Lawson; Li Wang; Henry Ooi; Douglas B Sawyer; Marvin W Kronenberg
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Publication Detail:
Type:  Journal Article     Date:  2014-08-27
Journal Detail:
Title:  Journal of the American Heart Association     Volume:  3     ISSN:  2047-9980     ISO Abbreviation:  J Am Heart Assoc     Publication Date:  2014  
Date Detail:
Created Date:  2014-08-28     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101580524     Medline TA:  J Am Heart Assoc     Country:  England    
Other Details:
Languages:  eng     Pagination:  -     Citation Subset:  IM    
Copyright Information:
© 2014 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.
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