Effect of Spironolactone on Left Ventricular Ejection Fraction and Volumes in Patients With Class I or II Heart Failure

Vizzardi, Enrico; D’Aloia, Antonio; Giubbini, Raffaele; Bordonali, Tania; Bugatti, Silvia; Pezzali, Natalia; Romeo, Alessia; Dei, Alessandra; Metra, Marco; Dei, Livio

doi:10.1016/j.amjcard.2010.06.052

Cited by 65 publications

(44 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…They can improve the hemodynamic properties of patients with cirrhosis and may decrease the severe symptoms of heart failure [85]. According to the data obtained from the RALES (Randomized Aldactone Evaluation Study) trial, a 30% reduction in all-cause mortality and a reduced risk of sudden cardiac death can be reached with the use of spironolactone in patients with chronic heart failure (left ventricular EF <35%) [86]. The selective aldosterone blocker, eplerenone has also been shown to reduce cardiovascular deaths and hospitalizations due to heart failure in a wider range of patients [87].…”

Section: Aldosterone Receptor Antagonistsmentioning

confidence: 99%

Pathophysiological and Clinical Approach to Cirrhotic Cardiomyopathy

Páll¹,

Czifra²,

Vitális³

et al. 2014

JGLD

View full text Add to dashboard Cite

Hyperdynamic circulation, systolic and diastolic left ventricular dysfunction and certain electrophysiological abnormalities have been associated with cirrhosis and known for a long time. These clinical features have been introduced as cirrhotic cardiomyopathy (CCM), which is characterized by blunted myocardial contractile responsiveness to physical, physiological and pharmacological stress. Importantly, cardiac dysfunction can be reversible and can improve due to effective medical treatment and also after liver transplantation. Echocardiography and electrocardiography are essential tools for recognizing the characteristic changes in the myocardial function and also the alterations in the electrophysiological properties of the heart. Laboratory markers are auxiliary modalities further aiding the establishment of the correct diagnosis. In this review, we aimed to collect the pathophysiological background and clinical characteristics of CCM with the intention of summarizing the current possibilities for the diagnosis establishment and treatment of this cardio-hepatic disorder.Abbreviations: A: late diastolic transmitral peak flow velocity; ACE: angiotensin converting enzyme; ANP: atrial natriuretic peptide; ARB: angiotensin receptor blocker; BNP: brain natriuretic peptide; cAMP: cyclic adenosine monophosphate; CCM: cirrhotic cardiomyopathy; CGRP: calcitonin gene-related peptide; CO: carbon monoxide; DD: diastolic dysfunction; DT: deceleration time; E: early diastolic transmitral peak flow velocity; Ea: early diastolic velocity of the septal mitral annulus; EF: ejection fraction; MUGA: Multi Gated Acquisition Scan; NO: nitric oxide; NSBB: non-selective beta-blocker; pro-BNP: pro-brain natriuretic peptide; QTc: corrected QT interval; RAAS: renin-angiotensin aldosterone system; RALES: Randomized Aldactone Evaluation Study; suPAR: urokinase-type plasminogen activator receptor; TDI: Tissue Doppler Imaging; TIPS: transjugular intrahepatic portosystemic shunt; TNF-alpha: tumor necrosis factor-alpha.

show abstract

Section: Aldosterone Receptor Antagonistsmentioning

confidence: 99%

Pathophysiological and Clinical Approach to Cirrhotic Cardiomyopathy

Páll¹,

Czifra²,

Vitális³

et al. 2014

JGLD

View full text Add to dashboard Cite

show abstract

“…Studies of the effects of aldosterone antagonists on LV remodeling in post-MI patients with LVEF < 40% and chronic heart failure have produced controversial results [9][10][11]. In a study conducted by Hayashi et al [5], spironolactone administration was randomized independent of LV systolic function and heart failure symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…Spironolactone was used at doses of 25-50 mg/day in the RALES study [8]. In several other studies, 25-100 mg/day of spironolactone and 50 mg/day of eplerenone were used [5,[9][10][11]. However, no studies have compared the efficacies of different dosages.…”

Section: Discussionmentioning

confidence: 99%

Does Spironolactone Have a Dose‐Dependent Effect on Left Ventricular Remodeling in Patients with Preserved Left Ventricular Function After an Acute Myocardial Infarction?

Vatankulu

Bacaksız

Sönmez

et al. 2013

Cardiovascular Therapeutics

View full text Add to dashboard Cite

SUMMARYAims: The aim of this study was to investigate the effects of spironolactone on left ventricular (LV) remodeling in patients with preserved LV function following acute myocardial infarction (AMI). Methods and Results: Successfully revascularized patients (n = 186) with acute ST elevation MI (STEMI) were included in the study. Patients were randomly divided into three groups, each of which was administered a different dose of spironolactone (12.5, 25 mg, or none). Echocardiography was performed within the first 3 days and at 6 months after MI. Echocardiography control was performed on 160 patients at a 6-month follow-up. The median left ventricular ejection fraction (LVEF) increased significantly in all groups, but no significant difference was observed between groups (P = 0.13). At the end of the sixth month, the myocardial performance index (MPI) had improved in each of the three groups, but no significant difference was found between groups (F = 2.00, P = 0.15). The mean LV peak systolic velocities (S m ) increased only in the control group during the follow-up period, but there is no significant difference between groups (F = 1.79, P = 0.18). The left ventricular end-systolic volume index (LVESVI) and the left ventricular end-diastolic volume index (LVEDVI) did not change significantly compared with the basal values between groups (F = 0.05, P = 0.81 and F = 1.03, P = 0.31, respectively). Conclusion: In conclusion, spironolactone dosages of up to 25 mg do not augment optimal medical treatment for LV remodeling in patients with preserved cardiac functions after AMI.

show abstract

“…En el estudio EMPHASIS-HF (Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure, n = 2.737) con 21 meses de seguimiento y 50 mg de eplerenona añadidos al tratamiento estándar de IC moderada, se observó una reducción de 24% del riesgo de mortalidad cardiovascular y de 29% de las hospitalizaciones por complicaciones cardiacas 19 . Ensayos clínicos de menor tamaño muestral en pacientes con IC leve tratados con ARM han demostrado un aumento significativo de la FEVI y una disminución de la expresión de marcadores de remodelamiento miocárdico [20][21][22][23] . Tabla 2 resume los principales ensayos clínicos realizados.…”

Section: Arm En Insuficiencia Cardiacaunclassified

“…Ensayos clínicos en pacientes con IC y disfunción sistólica muestran mejoras de la función diastólica dentro de sus hallazgos ecocardiográficos 23 . Estudios experimentales en ratas hipertensas que desarrollan ICD han demostrado un aumento de la expresión del RM miocárdica 24 .…”

Section: Arm En Insuficiencia Cardiaca Diastólicaunclassified