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01-12-2015 | Original Paper

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

Authors: Enrico Vizzardi, Edoardo Sciatti, Ivano Bonadei, Antonio D’Aloia, Lamia Tartière-Kesri, Jean-Michel Tartière, Alain Cohen-Solal, Marco Metra

Published in: Clinical Research in Cardiology | Issue 12/2015

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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Title: Effects of spironolactone on ventricular-arterial coupling in patients with chronic systolic heart failure and mild symptoms
Authors: Enrico Vizzardi
Edoardo Sciatti
Ivano Bonadei
Antonio D’Aloia
Lamia Tartière-Kesri
Jean-Michel Tartière
Alain Cohen-Solal
Marco Metra
Publication date: 01-12-2015
Publisher: Springer Berlin Heidelberg
Published in: Clinical Research in Cardiology / Issue 12/2015
Print ISSN: 1861-0684
Electronic ISSN: 1861-0692
DOI: https://doi.org/10.1007/s00392-015-0877-5

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