Document Detail

Relation of aldosterone "escape" despite angiotensin-converting enzyme inhibitor administration to impaired exercise capacity in chronic congestive heart failure secondary to ischemic or idiopathic dilated cardiomyopathy.
MedLine Citation:
PMID:  11835920     Owner:  NLM     Status:  MEDLINE    
In patients with chronic congestive heart failure (CHF), aldosterone production may occur despite the administration of angiotensin-converting enzyme (ACE) inhibitors. This phenomenon has been termed aldosterone "escape"; its relation to the severity of the disease is unknown. We sought to assess whether aldosterone escape might be related to disease severity or functional impairment in patients with CHF. One hundred forty-one consecutive patients with CHF who received ACE inhibitors (> 6 months) underwent an evaluation of neurohormonal activation and body composition, an echo-Doppler examination, and a cardiopulmonary exercise test. Aldosterone escape was defined as plasma levels of aldosterone above the normal range in our laboratory (> 0.42 nmol/L). Fourteen patients (10%) had aldosterone escape. There were no differences between patients with and without aldosterone escape with regard to age, New York Heart Association class, neurohormonal activation, ACE inhibitor dose, hemodynamics, or skeletal muscle bulk. In contrast, mean peak oxygen consumption (14.2 +/- 3.5 vs 17.3 +/- 4.9 ml/min/kg, p < 0.05) and the slope of the relation between ventilation and carbon dioxide production (41 +/- 7 vs 36 +/- 6, p <0.05) were significantly worse in patients with aldosterone escape compared with those without it. Thus, aldosterone escape is associated with reduced exercise capacity in patients with CHF. This factor does not seem to be linked with hemodynamic mechanisms or with a reduced skeletal muscle bulk.
Mariantonietta Cicoira; Luisa Zanolla; Lorenzo Franceschini; Andrea Rossi; Giorgio Golia; Prisca Zeni; Beatrice Caruso; Piero Zardini
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The American journal of cardiology     Volume:  89     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2002 Feb 
Date Detail:
Created Date:  2002-02-11     Completed Date:  2002-03-06     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  403-7     Citation Subset:  AIM; IM    
Divisione Clinicizzata di Cardiologia, Universita' degli Studi di Verona, Verona, Italy.
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MeSH Terms
Aldosterone / metabolism*
Angiotensin-Converting Enzyme Inhibitors / pharmacology*,  therapeutic use*
Cardiomyopathy, Dilated / complications
Chronic Disease
Echocardiography, Doppler
Exercise Test
Exercise Tolerance / physiology*
Heart Failure / etiology,  physiopathology*,  ultrasonography
Middle Aged
Myocardial Ischemia / complications
Prospective Studies
Renin-Angiotensin System / drug effects,  physiology
Reg. No./Substance:
0/Angiotensin-Converting Enzyme Inhibitors; 52-39-1/Aldosterone

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