Department of Medicine and Biological Science, Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan.
Int J Cardiol. 2013 Jul 15;167(1):244-9. doi: 10.1016/j.ijcard.2011.12.080. Epub 2012 Jan 14.
Aldosterone prevents norepinephrine uptake and promotes structural remodeling of the heart. Spironolactone is well known to have an anti-aldosteronergic effect, and this agent could improve cardiac sympathetic nerve activity (CSNA) in patients with chronic heart failure (CHF). On the other hand, we previously reported that the delta washout rate (WR) determined from serial (123)I-MIBG scintigraphic studies is the best currently available prognostic value in patients with CHF.
In total 208 patients with CHF (left ventricular ejection fraction [LVEF] <45%), but no cardiac events for at least 5 months, were identified on the basis of a history of decompensated acute heart failure requiring hospitalization. These patients underwent (123)I-MIBG scintigraphy and echocardiography just before leaving the hospital and after 6 months of treatment. The patients were retrospectively divided into a spironolactone (n=82) and a non-spironolactone (n=126) group.
The extents of changes in (123)I-MIBG scintigraphic and echocardiographic parameters in the spironolactone group were significantly better than those in the non-spironolactone group. Of the 208 patients, 56 experienced fatal cardiac events during the study. The mean follow-up period was 4.45+/-1.82 years. On Kaplan-Meier analysis, the rate freedom from cardiac death was 81.7% (67/82) in the spironolactone group and 67.5% (85/126) in the non-spironolactone group (P<0.05). Moreover, stepwise multivariate analyses showed spironolactone therapy to have the most independent and significant negative relationship with delta-WR, during the period from hospital discharge until 6 months after starting treatment, in patients with CHF (P<0.001).
Spironolactone treatment improves CSNA and prevents LV remodeling in patients with CHF. Furthermore, this agent is potentially effective for reducing the incidence of fatal cardiac events in CHF patients.
醛固酮可阻止去甲肾上腺素摄取并促进心脏结构重塑。螺内酯具有明确的抗醛固酮作用，可改善慢性心力衰竭（CHF）患者的心脏交感神经活性（CSNA）。另一方面，我们之前报道，从系列 123I-MIBG 闪烁显像研究中确定的δ洗脱率（WR）是 CHF 患者目前最具预后价值的指标。
根据因失代偿性急性心力衰竭需要住院治疗而导致心力衰竭恶化的病史，确定 208 例 CHF 患者（左心室射血分数[LVEF] <45%）在至少 5 个月内无心脏事件。这些患者在出院前和治疗 6 个月后进行 123I-MIBG 闪烁显像和超声心动图检查。患者回顾性地分为螺内酯组（n=82）和非螺内酯组（n=126）。
螺内酯组 123I-MIBG 闪烁显像和超声心动图参数变化的程度明显优于非螺内酯组。在 208 例患者中，56 例在研究期间发生致命性心脏事件。平均随访时间为 4.45±1.82 年。在 Kaplan-Meier 分析中，螺内酯组的心脏死亡无事件率为 81.7%（67/82），而非螺内酯组为 67.5%（85/126）（P<0.05）。此外，逐步多变量分析显示，在从出院到开始治疗后 6 个月的时间内，螺内酯治疗与 CHF 患者的 δ-WR 呈最独立和显著的负相关（P<0.001）。
螺内酯治疗可改善 CHF 患者的 CSNA 并预防 LV 重塑。此外，该药物可能有效降低 CHF 患者致命性心脏事件的发生率。
