Kurrelmeyer Karla M, Ashton Yelena, Xu Jiaqiong, Nagueh Sherif F, Torre-Amione Guillermo, Deswal Anita
Methodist DeBakey Heart and Vascular Center, Department of Cardiology, Houston, Texas.
Houston Hospital Research Institute, Houston, Texas.
J Card Fail. 2014 Aug;20(8):560-8. doi: 10.1016/j.cardfail.2014.05.010. Epub 2014 Jun 4.
Although spironolactone has been shown to decrease morbidity and mortality in patients with heart failure and reduced left ventricular ejection fraction, its role in patients with heart failure and preserved left ventricular ejection fraction (HFpEF) is not well defined. In this study we investigated the mechanisms involved when elderly women with HFpEF are treated with spironolactone.
Forty-eight women with HFpEF were enrolled in a randomized placebo-controlled trial and were assigned to 25 mg spironolactone daily (n = 24) or placebo (n = 24) for 6 months. Six-minute walk distance, clinical composite score, Doppler echocardiography, and biomarkers were determined at baseline and after 3 and 6 months of therapy. Six months of spironolactone treatment stabilized clinical symptoms, as demonstrated by significant worsening of the clinical composite score in the placebo group (P = .02). In addition, spironolactone treatment improved diastolic function by significantly increasing early diastolic tissue Doppler velocity of the lateral mitral annulus (lateral e'; P = .003) and significantly reducing the mitral peak E velocity to lateral e' ratio (lateral E/e'; P = .0001). Finally, spironolactone favorably affected remodeling through a reduction in myocardial fibrosis measured by a reduction in type III procollagen levels (P = .035). Six-minute walk distance did not significantly improve with spironolactone treatment compared with placebo.
Spironolactone stabilizes functional capacity and symptoms and improves diastolic function, possibly through its ability to suppress type III procollagen synthesis.
尽管螺内酯已被证明可降低心力衰竭且左心室射血分数降低患者的发病率和死亡率，但其在心力衰竭且左心室射血分数保留（HFpEF）患者中的作用尚不明确。在本研究中，我们调查了HFpEF老年女性接受螺内酯治疗时涉及的机制。
48名HFpEF女性患者参加了一项随机安慰剂对照试验，被分配至每日服用25mg螺内酯组（n = 24）或安慰剂组（n = 24），为期6个月。在基线以及治疗3个月和6个月后测定6分钟步行距离、临床综合评分、多普勒超声心动图和生物标志物。6个月的螺内酯治疗使临床症状稳定，安慰剂组临床综合评分显著恶化证明了这一点（P = .02）。此外，螺内酯治疗通过显著增加二尖瓣环外侧舒张早期组织多普勒速度（外侧e'；P = .003）和显著降低二尖瓣E峰速度与外侧e'比值（外侧E/e'；P = .0001）改善了舒张功能。最后，螺内酯通过降低III型前胶原水平来测量心肌纤维化，从而对心脏重塑产生有利影响（P = .035）。与安慰剂相比，螺内酯治疗后6分钟步行距离没有显著改善。
螺内酯可稳定功能能力和症状，并改善舒张功能，可能是通过其抑制III型前胶原合成的能力实现的。
