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Effects of spironolactone on ventricular-arterial coupling in patients with chronic systolic heart failure and mild symptoms

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Abstract

Background

Several studies demonstrated that mineralocorticoid receptor antagonists (MRAs) are able to prevent myocardial and vascular fibrosis, and left ventricular (LV) remodeling in patients with systolic chronic heart failure (HF) and mild symptoms. Ventricular-arterial coupling (VAC) should be influenced by anti-fibrotic interventions. We have assessed the effects of spironolactone on VAC and its components, aortic elastance (Ea) and end-systolic LV elastance (Ees), in patients with HF.

Methods and results

Changes from baseline in VAC were compared between 65 patients treated with spironolactone and 32 controls not receiving MRAs. All patients had HF, reduced LVEF with reduced LV ejection fraction (LVEF) and New York Heart Association (NYHA) functional class I–II symptoms, and underwent transthoracic echocardiography at baseline and after 6 months. VAC was estimated by the modified single-beat method as Ea/Ees. Parameters of LV function improved after 6 month treatment with spironolactone with an increase in the LVEF from 34 ± 8 to 39 ± 8 % (p < 0.001). Spironolactone increased Ees from 1.32 ± 0.38 to 1.57 ± 0.42 mmHg/mL (p < 0.001) and reduced VAC from 2.03 ± 0.59 to 1.66 ± 0.31 (p < 0.001), but did not affect Ea and V0 (LV volume at end-systolic pressure of 0 mmHg). No change in any of these parameters occurred in the control group.

Conclusions

6-month therapy with spironolactone improved VAC mainly through its effect on Ees in patients with mild HF.

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Authors and Affiliations

  1. Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Study of Brescia, Brescia, Italy

    Enrico Vizzardi, Edoardo Sciatti, Ivano Bonadei, Antonio D’Aloia & Marco Metra

  2. Cardiology Department, Lariboisière Hospital and Denis Diderot University, Paris, France

    Alain Cohen-Solal

  3. Cardiac Rehabilitation, Léon Bérard Hospital, Hyères, France

    Lamia Tartière-Kesri

  4. Cardiology Department, Sainte Musse Hospital, Toulon, France

    Lamia Tartière-Kesri & Jean-Michel Tartière

  5. INSERM U942, Paris, France

    Jean-Michel Tartière & Alain Cohen-Solal

  6. Piazzale Spedali Civili 1, 25123, Brescia, Italy

    Enrico Vizzardi

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  1. Enrico Vizzardi
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Correspondence to Enrico Vizzardi.

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Vizzardi, E., Sciatti, E., Bonadei, I. et al. Effects of spironolactone on ventricular-arterial coupling in patients with chronic systolic heart failure and mild symptoms. Clin Res Cardiol 104, 1078–1087 (2015). https://doi.org/10.1007/s00392-015-0877-5

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  • DOI: https://doi.org/10.1007/s00392-015-0877-5

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