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Spironolactone Improves Cardiac Sympathetic Nerve Activity and Symptoms in Patients with Congestive Heart Failure

¹ Second Department of Internal Medicine, Gunma University School of Medicine, Maebashi, Japan
² Kitakanto Cardiovascular Hospital, Gunma, Japan

We evaluated whether spironolactone would improve cardiac sympathetic nerve activity and symptoms in patients with congestive heart failure (CHF). Methods: Thirty patients with CHF (left ventricular ejection fraction [LVEF] < 40%; mean, 30% ± 9%) were treated with an angiotensin-converting enzyme inhibitor, a loop diuretic, and, in most cases, digoxin. Fifteen patients (group A) were assigned to additionally receive spironolactone (12.5–50 mg/day), and the remaining 15 patients (group B) continued their current regimen. Patients were studied before and 6 mo after treatment. The delayed heart-to-mediastinum count ratio (H/M ratio), delayed total defect score (TDS), and washout rate (WR) were determined from ¹²³I-meta-iodobenzylguanidine (MIBG) images. LVEF was determined by echocardiography, and New York Heart Association (NYHA) functional class was estimated. Results: Before treatment, LVEF, TDS, H/M ratio, WR, and NYHA functional class were similar in both groups. With treatment, LVEF did not significantly improve in either group. However, after treatment in group A, TDS decreased from 37 ± 9 to 25 ± 13 (P = 0.0001), H/M ratio increased from 1.62 ± 0.20 to 1.83 ± 0.27 (P < 0.0001), and WR decreased from 51 ± 9 to 40 ± 15 (P < 0.001). In group B, these parameters did not significantly change. NYHA functional class improved in both groups (in group A, from 3.3 ± 0.5 to 1.7 ± 0.5 [P < 0.0001]; in group B, from 3.3 ± 0.5 to 2.4 ± 0.6 [P = 0.01]); this was a significantly greater improvement in group A than in group B (P < 0.01). Conclusion: Spironolactone improves cardiac sympathetic nerve activity and symptoms in patients with CHF.

Key Words: radionuclide imaging • heart failure • aldosterone

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