Aldosterone Blockade Ups Left Ventricular Diastolic Function
(HealthDay News) – For patients with heart failure with preserved ejection fraction, aldosterone blockade with spironolactone improves left ventricular diastolic function, but has no impact on maximal exercise capacity, quality of life, or patient symptoms, according to a study published in the Feb. 27 issue of the Journal of the American Medical Association.
In an effort to examine the efficacy and safety of long-term aldosterone receptor blockade, Frank Edelmann, MD, from the University of Göttingen in Germany, and colleagues conducted a prospective, double-blind trial at 10 sites, involving 422 ambulatory patients (mean age 67 years; 52% female) with chronic New York Heart Association class II or III heart failure, preserved left ventricular ejection fraction of ≥50%, and evidence of diastolic dysfunction. Participants were randomized to receive once daily spironolactone (213 patients) or placebo (209 patients) and were followed for 12 months.
The researchers found that diastolic dysfunction decreased with spironolactone and increased with placebo (adjusted mean difference, −1.5; P <0.001). There was no significant change in peak maximal exercise capacity with spironolactone vs. placebo. Reverse remodeling and improved neuroendocrine activation were induced by spironolactone, but there was no improvement in heart failure symptoms or quality of life, and a slight reduction in six-minute walking distance. There was also a modest increase in serum potassium levels and decreased estimated glomerular filtration rate with spironolactone, with no impact on hospitalizations.
"Whether the improved left ventricular function observed in the Aldosterone Receptor Blockade in Diastolic Heart Failure trial is of clinical significance requires further investigation in larger populations," the authors write.
Several authors disclosed financial ties to the pharmaceutical and medical technology industries.