Effect of Early Spironolactone on the ST2 Level and Clinical Changes in Acute Decompensated Heart Failure Patients

Abstract

Background: In spite of major advances in therapy, morbidity, and mortality due to acute decom­pen­sated heart failure (ADHF) remain poor. Early initiation of mineralocorticoid antagonist (spironolactone) may increase the suppression of negative effect of renin-angiotensin-aldosterone system ( RAAS ) activation , even though it already uses ACE I /ARB accompanying ADHF and give a better outcome. This study aims to determine the effect of early spironolactone 100 mg a day for 3 consecutive days on the s uppression of tumorigenicity 2 (ST2) level and clinical changes in patients with ADHF . Subjects and Method: This was a randomized single blind controlled trial. Thirty eight conse ­ cutive patients with ADHF hospitalized at Dr. Moewardi Hospital , Surakarta were randomized into two groups: spironolactone group (standard therapy plus spironolactone 100 mg per day for 3 day, n=19) and control group (standard therapy, n=19). Clinical sign and simptom of ADHF was monitored everyday and the difference of clinical changes was evaluated at the day-3. Venous blood samples were collected from all patients at the first day prior therapy and day-4 after therapy. The dependent variable was ST2 level . The independent variable was Spironolacton therapy . The data were analyzed by independent t-test. Results: Decreased levels of ST2 in the spironolactone group (mean= 36.96 ; SD= 21.29 ) was higher than the control group (mean= 19.73 ; SD= 16.48 ) and it was statistically significant ( p= 0 . 008). Spironolacton therapy 100 mg once daily at the first 3 day in patient with ADHF was safe, no hiperkalemia , or worsening renal function . T here was decreasing risk of hipokalemia up to 33% (RR = 0 . 33 ; 95% CI = 0 . 1 to 1 . 0; p= 0 . 036) and greater proportion patient with improvement clinical simptom and sign of ADHF at day-3 in the spironolactone group vs control group. Conclusion: Administration of spironolactone 100 mg at the first 3 day plus standard therapy decreases levels of ST2, safe, decreases risk of hipokalemia and give greater proportion of clinical improvement patients ADHF . Keywords: Spironolactone, ADHF, ST2 Correspondence: Trisulo Wasyanto . Department of Cardiology and Vascular Medicine, Faculty of Medicine, Uni ­ versitas Sebelas Maret /Dr. Moewardi Hospital . Jl. Kol. Sutarto 132 , Surakarta 57126 . Indonesia . Email: trisulo.wasyanto@gmail.com. Indonesian Journal of Medicine (2019), 4(3): 232-240 https://doi.org/10.26911/theijmed.2019.04.03.06