RT Journal Article SR Electronic T1 Additive Effects of Spironolactone and Candesartan on Cardiac Sympathetic Nerve Activity and Left Ventricular Remodeling in Patients with Congestive Heart Failure JF Journal of Nuclear Medicine JO J Nucl Med FD Society of Nuclear Medicine SP 1993 OP 2000 DO 10.2967/jnumed.107.045427 VO 48 IS 12 A1 Shu Kasama A1 Takuji Toyama A1 Hiroyuki Sumino A1 Naoya Matsumoto A1 Yuichi Sato A1 Hisao Kumakura A1 Yoshiaki Takayama A1 Shuichi Ichikawa A1 Tadashi Suzuki A1 Masahiko Kurabayashi YR 2007 UL http://jnm.snmjournals.org/content/48/12/1993.abstract AB The activation of the renin–angiotensin–aldosterone system prevents the uptake of norepinephrine in the myocardium. However, the additive effects of combined spironolactone and candesartan on cardiac sympathetic nerve activity (CSNA) have not been determined. We investigated the effects of the angiotensin-receptor blocker candesartan alone and in combination with spironolactone on CSNA in patients with congestive heart failure (CHF). Methods: Fifty patients with CHF (left ventricular ejection fraction [LVEF] < 45%) were randomly assigned to candesartan plus spironolactone (group A; n = 25) or to candesartan alone (group B; n = 25). All patients were also treated with a loop diuretic. The delayed percent denervation, delayed heart-to-mediastinum count (H/M) ratio, and washout rate (WR) were determined from 123I-metaiodobenzylguanidine (MIBG) scintigraphy, and plasma brain natriuretic peptide (BNP) concentration was measured before and 6 mo after treatment. The LV end-diastolic volume (LVEDV), LV end-systolic volume (LVESV), and LVEF were also determined by echocardiography. Results: After 6 mo, all of these parameters were improved in both groups. However, the degree of change in the percent denervation was −14 ± 12 in group A and −7 ± 10 in group B (P < 0.05); the change in the H/M ratio was 0.19 ± 0.18 in group A and 0.08 ± 0.14 in group B (P < 0.05), the change in WR was −12% ± 8% in group A and −5% ± 13% in group B (P < 0.05), and the change in plasma BNP was −100 ± 83 pg/mL in group A and −43 ± 97 pg/mL in group B (P < 0.05). The degree of change in LVEDV, LVESV, and LVEF in group A tended to be better than that in group B, but these changes were not statistically significant. Moreover, there were significant correlations between changes in the 123I-MIBG scintigraphic findings and changes in the LVEDV (% denervation, r = 0.692, P < 0.001; H/M ratio, r = −0.437, P < 0.05; and WR, r = 0.505, P < 0.01) or the LVESV (% denervation, r = 0.663, P < 0.001; H/M ratio, r = −0.438, P < 0.05; and WR, r = 0.532, P < 0.01) in group A. In contrast, there was no relationship between these parameters in group B. Conclusion: These findings indicate that the combination of spironolactone and candesartan may be more beneficial for CSNA and LV performance than candesartan alone in patients with CHF.