Spironolacton reduces left ventricular diastolic stiffness, remodeling and improves functional status in hypertensive patients with preserved ejection fraction heart failure

Abstract

Mineralocorticoid receptor antagonists have been shown to be beneficial in treatment and mortality reduction in heart failure with reduced ejection fraction in randomized trials. Data regarding their usefulness in HFPEF remains to be studied. We studied the effects of spironolacton (S) on diastolic stiffness and LV remodeling in diabetic pts with HFPEF. Methods: 137 pts 64±12 yrs (56% female) with HFPEF NYHA III with diabetes mellitus and without renal failure were randomized to two groups in order to receive S on top of their treatment (n=68) 25mg/day to further increase to 50mg/day after 8 weeks if no hyperkalemia (>5.5 mmol/l) has been developed or amilorid (A) 2.5 mg/day to increase to 5mg/day after 8 weeks in pts without hyperkalemia (n=69) for 6 months. Medications as ACEI/ARB, β-blockers, loop diuretics were evenly distributed in groups. NTproBNP levels, and diastolic wall stress (DWS) as (PWs - PWd) /PWs, LV mass index (LVMI), septal E/Em, LA volume index (LAVI) were measured by EchoCG by two independent observers unaware of the aim of the study in 1, 30, 90 and 180 days follow up. Results: In 30 days there were no significant changes in all parameters. In 90 day E/Em were significantly less in S compared with A (10.8±2.3 vs 12.1±3.1, p<0.05) without changes in other parameters. This difference remained unchanged throughout the study. In 180 days DWS, LVMI, LAVI and NTproBNP levels were significantly better in S group. (DWS: S 0.37±0.3 vs A 0.31±0.2, p<0.03; LWMI: male S 114±6 vs A 118±8, p<0.05; female S 96±5 vs A 110±3, p<0.05; LAVI: S 28±5 vs 32±7, p<0.03; NTproBNP S 938±69 vs A 1602±197 pg/ml p<0.02). Conclusion: In our study spironolacton reduces diastolic stiffness and alters LV and LA remodeling as well as NTproBNP levels in diabetic pts with HFPEF.