Document Detail


Mineralocorticoid receptor antagonist spironolactone improves left ventricular remodeling in patients with congestive heart failure and acute myocardial infarction.
MedLine Citation:
PMID:  15277727     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Randomized aldactone evolution study (RALES) and eplerenone post-AMI heart failure efficacy and survival study (EPHESUS) had shown that aldosterone blockade (AB) with standard therapy resulted in a reduction in mortality in patients with congestive heart failure (CHF) and acute myocardial infarction (AMI). However, the mechanism for the beneficial effect of AB remains unknown. To evaluate the effect of spironolactone (Spi) on left ventricular (LV) remodeling, 34 CHF patients with DCM were randomly divided into the Spi (+) or Spi (-) groups. Four months of treatment with Spi improved the LV volume and mass. To evaluate the effect of Spi on post-infarct LV remodeling, 134 patients with first anterior AMI were randomly divided into the Spi (+) or Spi (-) groups after revascularization. LV ejection fraction was significantly improved after 1 month in the Spi (+) group compared with that in the Spi (-) group. LV end-diastolic volume index was significantly suppressed in the Spi (+) group compared with that in the Spi (-) group. Transcardiac extraction of aldosterone through the heart was significantly suppressed in the Spi (+) group and was significant lower in the Spi (+) group compared with the Spi (-) group. These findings indicate that AB combined with standard therapy can prevent LV remodeling in patients with CHF and AMI, suggesting that the failing heart is the target organ of the aldosterone.
Authors:
Takayoshi Tsutamoto
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial; Review    
Journal Detail:
Title:  Nihon yakurigaku zasshi. Folia pharmacologica Japonica     Volume:  124     ISSN:  0015-5691     ISO Abbreviation:  Nippon Yakurigaku Zasshi     Publication Date:  2004 Aug 
Date Detail:
Created Date:  2004-07-27     Completed Date:  2004-10-25     Revised Date:  2011-07-27    
Medline Journal Info:
Nlm Unique ID:  0420550     Medline TA:  Nihon Yakurigaku Zasshi     Country:  Japan    
Other Details:
Languages:  eng     Pagination:  90-100     Citation Subset:  IM    
Affiliation:
Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Seta-Tsukinowa, Otsu 520-2192, Japan. tutamoto@belle.shiga-med.ac.jp
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aldosterone Antagonists / pharmacology,  therapeutic use*
Female
Heart Failure / drug therapy*,  physiopathology
Humans
Male
Middle Aged
Myocardial Infarction / physiopathology
Randomized Controlled Trials as Topic
Spironolactone / pharmacology,  therapeutic use*
Ventricular Remodeling / drug effects*
Chemical
Reg. No./Substance:
0/Aldosterone Antagonists; 52-01-7/Spironolactone

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


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