Cicoira Mariantonietta, Zanolla Luisa, Rossi Andrea, Golia Giorgio, Franceschini Lorenzo, Brighetti Giovanna, Marino Paolo, Zardini Piero
Dipartimento di Scienze Biomediche e Chirurgiche, Sezione di Cardiologia Università degli Studi di Verona, P. Le Stefani, I-37126 Verona, Italy.
J Am Coll Cardiol. 2002 Jul 17;40(2):304-10. doi: 10.1016/s0735-1097(02)01965-4.
This study was designed to assess the effects of spironolactone (SP) on left ventricular (LV) function and exercise tolerance in patients with chronic heart failure (CHF).
In severe heart failure (HF), SP improves survival, but the underlying mechanisms are not clear.
We randomized 106 outpatients with HF to SP (12.5 to 50 mg/day) (group 1) or control (group 2). Complete echocardiography and cardiopulmonary exercise testing were performed at baseline and 12 months after randomization.
Left ventricular end-systolic volume at baseline and at follow-up was 188 +/- 94 ml and 171 +/- 97 ml in group 1 and 173 +/- 71 ml and 168 +/- 79 ml in group 2 (treatment group-by-time interaction, p = 0.03). Left ventricular ejection fraction at baseline and at follow-up was 33 +/- 7% and 36 +/- 9% in group 1 and 34 +/- 7% and 34 +/- 9% in group 2 (treatment group-by-time interaction, p = 0.02). At baseline, 9 patients in group 1 and 3 patients in group 2 had a restrictive mitral filling pattern, a marker of severe diastolic dysfunction; at follow-up, 3 patients in group 1 and no patient in group 2 improved their pattern. No patient in group 1 and 4 patients in group 2 worsened their pattern (chi-square, p = 0.02). Peak oxygen consumption increased significantly in patients treated with 50 mg of SP and decreased in group 2 (17.7 +/- 5.2 vs. 18.5 +/- 5.9 and 19.1 +/- 5.6 vs. 17.9 +/- 5.3, respectively; analysis of variance, p = 0.01).
Spironolactone improves LV volumes and function; furthermore, it improves exercise tolerance at the highest administered dose. Our data might explain the mortality reduction during aldosterone antagonism in patients with HF.
本研究旨在评估螺内酯（SP）对慢性心力衰竭（CHF）患者左心室（LV）功能和运动耐量的影响。
在严重心力衰竭（HF）中，SP可提高生存率，但其潜在机制尚不清楚。
我们将106例HF门诊患者随机分为SP组（12.5至50mg/天）（第1组）或对照组（第2组）。在基线和随机分组后12个月进行完整的超声心动图和心肺运动测试。
第1组基线和随访时的左心室收缩末期容积分别为188±94ml和171±97ml，第2组分别为173±71ml和168±79ml（治疗组与时间的交互作用，p = 0.03）。第1组基线和随访时的左心室射血分数分别为33±7%和36±9%，第2组分别为34±7%和34±9%（治疗组与时间的交互作用，p = 0.02）。基线时，第1组有9例患者和第2组有3例患者存在限制性二尖瓣充盈模式，这是严重舒张功能障碍的一个指标；随访时，第1组有3例患者改善了该模式，第2组无患者改善。第1组无患者和第2组有4例患者的模式恶化（卡方检验，p = 0.02）。接受50mg SP治疗的患者峰值耗氧量显著增加，第2组则降低（分别为17.7±5.2与18.5±5.9以及19.1±5.6与17.9±5.3；方差分析，p = 0.01）。
螺内酯可改善左心室容积和功能；此外，在最高给药剂量时可提高运动耐量。我们的数据可能解释了HF患者醛固酮拮抗期间死亡率降低的原因。
