Document Detail


Effect of spironolactone on left ventricular systolic and diastolic function in patients with early stage chronic kidney disease.
MedLine Citation:
PMID:  21059444     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Patients with early chronic kidney disease (CKD) have an increased risk for cardiovascular disease. Aldosterone levels are elevated and might impair ventricular function through adverse myocardial and vascular proinflammatory and fibrotic effects. In the Chronic Renal Impairment in Birmingham II (CRIB II) study, it was hypothesized that mineralocorticoid receptor blockade with spironolactone in addition to angiotensin-converting enzyme inhibitors or angiotensin receptor blockers would improve left ventricular (LV) function and markers of inflammation, ventricular stretch, and collagen turnover in early CKD. A total of 112 patients with early CKD were randomized to spironolactone 25 mg/day or placebo for 40 weeks. Ventricular function was assessed by echocardiography and cardiac magnetic resonance imaging tagging. High-sensitivity C-reactive protein, N-terminal-pro-B-type natriuretic peptide, and aminoterminal propeptide of type III procollagen were measured. Spironolactone improved LV long-axis systolic function (Sm 8.2 ± 1.4 vs 7.7 ± 1.3 cm/s, p <0.05), torsion (7.77 ± 1.61° vs 6.77 ± 1.48°, p <0.05), and myocardial deformation (strain rate -1.14 ± 0.24 vs -1.09 ± 0.20 s(-1), p <0.05) compared to placebo, without a change in the ejection fraction. Markers of LV relaxation (E/e' ratio 7.2 ± 2.3 vs 8.5 ± 2.3, p <0.05) and suction (M-mode propagation velocity 56 ± 12 vs 50 ± 12 cm/s, p <0.05) were also improved. Spironolactone reduced N-terminal-pro-B-type natriuretic peptide (24.8 pmol/L [range 0.4 to 122.4] vs 39.4 pmol/L [range 10.8 to 102.4], p <0.01) and attenuated an increase in aminoterminal propeptide of type III procollagen observed with placebo. In conclusion, spironolactone improves markers of regional LV systolic and diastolic function in early CKD.
Authors:
Nicola C Edwards; Charles J Ferro; Helen Kirkwood; Colin D Chue; Alistair A Young; Paul M Stewart; Richard P Steeds; Jonathan N Townend
Related Documents :
19357774 - Hypoxia induces dilated cardiomyopathy in the chick embryo: mechanism, intervention, an...
3613544 - Intrinsic indices of the left ventricle as a blood pump in normal and infarcted left ve...
19174444 - Speckle tracking for left ventricle performance in young athletes with bicuspid aortic ...
15526114 - Regional differences of myocardial infarct development and ischemic preconditioning.
19376404 - Cardiac hemodynamic profiles and pro-b-type natriuretic peptide in cirrhotic patients u...
7389064 - Effect of hemorrhagic shock on the performance, o2-consumption, and ultrastructure of i...
Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The American journal of cardiology     Volume:  106     ISSN:  1879-1913     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-11-09     Completed Date:  2010-12-02     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1505-11     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2010 Elsevier Inc. All rights reserved.
Affiliation:
Department of Cardiology, University Hospital Birmingham and University of Birmingham, Birmingham, United Kingdom. n.c.edwards@bham.ac.uk
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Aldosterone Antagonists / pharmacology*
Chronic Disease
Diastole / drug effects
Female
Humans
Kidney Diseases / physiopathology*
Male
Middle Aged
Severity of Illness Index
Spironolactone / pharmacology*
Systole / drug effects
Ventricular Function, Left / drug effects*
Grant Support
ID/Acronym/Agency:
//British Heart Foundation
Chemical
Reg. No./Substance:
0/Aldosterone Antagonists; 52-01-7/Spironolactone

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Left atrial volume in children without heart disease and in those with ventricular septal defect or ...
Next Document:  Comparison of intima-media thickness of the carotid artery and cardiovascular disease risk factors i...