Monday, August 13, 2007

Addition of spironolactone to ARB treatment benefits chronic HF patients

Addition of spironolactone to ARB treatment benefits chronic HF patients

13 August 2007

MedWire News: Patients with chronic mild-to-moderate HF have significantly improved left ventricular (LV) reverse modeling and function if they are treated with spironolactone in addition to an angiotensin II receptor blocker (ARB), study results indicate.

Recent research has suggested a positive effect of the aldosterone receptor blocker spironolactone on patients with severe HF, the researchers say.

John Sanderson (University of Birmingham, UK) and colleagues therefore investigated the effects of combining spironolactone with the ARB candesartan in 51 systolic HF patients with LV ejection fraction (LVEF) lower than 40%.

The participants were randomly assigned to receive candesartan plus spironolactone (combination group) or candesartan plus placebo (control group) for 1 year.

Reverse remodeling was assessed by serial cardiac magnetic resonance imaging and echocardiographic tissue Doppler imaging.

At 1-year, patients receiving candesartan and spironolactone had significant improvements in LVEF compared with the control group (35% vs 26%, p<0.01). They also had significant reductions in LV end-diastolic volume index (121 vs 155 ml/m2, p=0.001), end-systolic volume index (88 vs 120 ml/m2, p=0.0005), and LV mass index (81 vs 93 g/m2, p=0.002) compared with controls.

Patients receiving the combination therapy, but not those receiving candesartan alone, also showed a significant increase in peak basal systolic velocity and strain during the ejection phase, and a decrease in index of filling pressure.

Cycling variation integrated backscatter was also increased in the combination group, compared with the control group, which suggests a reduction in myocardial fibrosis, the team notes.

This study demonstrates a "beneficial role of dual blockade of angiotensin II and aldosterone receptors on the reverse remodeling process in chronic mild-to-moderate systolic HF," Sanderson and co-workers write in the Journal of the American College of Cardiology.

They add: "Further larger clinical studies are needed to determine whether spironolactone in conjunction with an ARB can reduce mortality or hospital stays for congestive HF."

Jay Cohn (University of Minnesota, Minneapolis) commented in a related editorial: "These observations lend credence to the concept that the favorable effect of aldosterone inhibition on cardiovascular outcomes can at least in part be attributed to their properties to inhibit structural remodeling."


J Am Coll Cardiol 2007; 50: 591-596

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