| Effect of spironolactone on cardiac sympathetic nerve activity and left ventricular remodeling in patients with dilated cardiomyopathy. | |
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MedLine Citation:
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PMID: 12598068 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: We sought to evaluate the effects of spironolactone on cardiac sympathetic nerve activity and left ventricular (LV) remodeling in patients with dilated cardiomyopathy (DCM). BACKGROUND: Aldosterone prevents the uptake of norepinephrine and promotes structural remodeling of the heart. Spironolactone, an aldosterone receptor blocker, improves LV remodeling in patients with DCM, but its influence on cardiac sympathetic nerve activity has not been determined. METHODS: We selected 30 patients with DCM who were treated with an angiotensin-converting enzyme inhibitor and a loop diuretic. Fifteen patients were assigned to receive spironolactone additionally, whereas the remaining 15 patients continued their current regimen. The delayed heart/mediastinum (H/M) count ratio, delayed total defect score (TDS), and washout rate (WR) were determined from iodine-123 ((123)I)-meta-iodobenzylguanidine (MIBG) images before and six months after treatment. The left ventricular end-diastolic volume (LVEDV) and left ventricular ejection fraction (LVEF) were determined by echocardiography, and New York Heart Association (NYHA) functional class was estimated. RESULTS: In the spironolactone group, the TDS decreased from 36 +/- 9 to 24 +/- 13 (p < 0.0001), the H/M ratio increased from 1.64 +/- 0.20 to 1.86 +/- 0.27 (p < 0.0001), and WR decreased from 55 +/- 12% to 41 +/- 15% (p < 0.0005). In addition, the LVEDV decreased from 187 +/- 26 to 154 +/- 41 ml (p < 0.005), and LVEF increased from 33 +/- 6% to 39 +/- 6% (p < 0.005). However, there were no significant changes in these parameters in the control group. There was a significant correlation between changes in the (123)I-MIBG findings and changes in LVEDV with spironolactone treatment (TDS: r = 0.684, p = 0.0038; H/M ratio: r = -0.878, p < 0.0001; and WR: r = 0.737, p = 0.0011). The NYHA functional class improved in both groups but showed a greater improvement in the spironolactone group than in the control group (p < 0.01). CONCLUSIONS: Spironolactone improves cardiac sympathetic nerve activity and LV remodeling in patients with DCM. |
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Authors:
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Shu Kasama; Takuji Toyama; Hisao Kumakura; Yoshiaki Takayama; Shuichi Ichikawa; Tadashi Suzuki; Masahiko Kurabayashi |
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Publication Detail:
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Type: Clinical Trial; Journal Article; Randomized Controlled Trial |
Journal Detail:
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Title: Journal of the American College of Cardiology Volume: 41 ISSN: 0735-1097 ISO Abbreviation: J. Am. Coll. Cardiol. Publication Date: 2003 Feb |
Date Detail:
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Created Date: 2003-02-24 Completed Date: 2003-03-12 Revised Date: 2010-03-23 |
Medline Journal Info:
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Nlm Unique ID: 8301365 Medline TA: J Am Coll Cardiol Country: United States |
Other Details:
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Languages: eng Pagination: 574-81 Citation Subset: AIM; IM |
Affiliation:
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Second Department of Internal Medicine, Gunma University School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma 371-0034, Japan. s-kasama@bay.wind.ne.jp |
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aged, 80 and over Aldosterone Antagonists / pharmacology*, therapeutic use* Cardiomyopathy, Dilated / diagnosis, drug therapy*, physiopathology* Echocardiography Female Follow-Up Studies Heart / drug effects*, innervation*, physiopathology Humans Male Middle Aged Radionuclide Imaging Spironolactone / pharmacology*, therapeutic use* Sympathetic Nervous System / drug effects*, physiopathology* Time Factors Ventricular Remodeling / drug effects*, physiology* |
| Chemical | |
Reg. No./Substance:
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0/Aldosterone Antagonists; 52-01-7/Spironolactone |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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