Abstract | OBJECTIVES: DESIGN: A prospective, randomised, double-blind, placebo-controlled study. SETTING: A university hospital. PATIENTS AND INTERVENTION: 113 patients (mean±SD age 58±8 years) with body mass index≥30, without any comorbidities, with impaired early diastolic mitral annular velocity, randomised to spironolactone 25 mg/day or placebo for 6 months. MAIN OUTCOME MEASURES: Echocardiographically derived indices of LV systolic (strain and strain rate) and diastolic (E velocity, tissue e' and E/e' ratio) function, myocardial reflectivity (calibrated integrated backscatter (IB)), and serum PICP and PIIINP. RESULTS: In the spironolactone group, significant improvements in myocardial deformation, peak early diastolic velocity (Em), E/e' and IB were noted with a simultaneous decrease in PICP and PIIINP. No corresponding alterations were found with placebo. Improvement in LV systolic function (increase in strain) was independently associated with baseline strain (β=-0.43, p<0.001), change in IB (β=0.26, p<0.02) and baseline PICP (β=0.24, p<0.04). Among the independent determinants of LV diastolic improvement were for increase in Em - baseline Em (β=-0.44, p<0.001) and baseline PICP (β=0.35, p<0.002), and for decrease in E/e' - baseline E/e' (β=-0.35, p<0.005) and change in PICP (β=0.25, p<0.04). CONCLUSIONS: In patients with obesity without other comorbidities, aldosterone antagonism improves LV function and myocardial acoustic properties, and reduces circulating procollagen levels. Beneficial changes in cardiac performance are independently predicted by baseline LV dysfunction and baseline disturbances, as well as treatment-induced improvements in fibrosis markers. CLINICAL TRIAL REGISTRATION: http://www.anzctr.org.au ACTRN12609000655246.
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Authors | Wojciech Kosmala, Monika Przewlocka-Kosmala, Hanna Szczepanik-Osadnik, Andrzej Mysiak, Thomas H Marwick |
Journal | Heart (British Cardiac Society)
(Heart)
Vol. 99
Issue 5
Pg. 320-6
(Mar 2013)
ISSN: 1468-201X [Electronic] England |
PMID | 23343682
(Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
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Chemical References |
- Mineralocorticoid Receptor Antagonists
- Spironolactone
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Topics |
- Body Mass Index
- Double-Blind Method
- Echocardiography, Doppler
- Female
- Fibrosis
- Follow-Up Studies
- Heart Ventricles
(diagnostic imaging, drug effects, physiopathology)
- Humans
- Male
- Middle Aged
- Mineralocorticoid Receptor Antagonists
(therapeutic use)
- Myocardium
(metabolism, pathology)
- Obesity
(complications, diagnosis, physiopathology)
- Prospective Studies
- Spironolactone
(therapeutic use)
- Treatment Outcome
- Ventricular Dysfunction, Left
(drug therapy, etiology, physiopathology)
- Ventricular Function, Left
(drug effects)
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