title: Spironolactone improves cardiac sympathetic nerve activity and symptoms in patients with congestive heart failure.
abstract: We evaluated whether spironolactone would improve cardiac sympathetic nerve activity and symptoms in patients with congestive heart failure (CHF).
  
  
  METHODS
  Thirty patients with CHF (left ventricular ejection fraction [LVEF] < 40%; mean, 30% +/- 9%) were treated with an angiotensin-converting enzyme inhibitor, a loop diuretic, and, in most cases, digoxin. Fifteen patients (group A) were assigned to additionally receive spironolactone (12.5-50 mg/day), and the remaining 15 patients (group B) continued their current regimen. Patients were studied before and 6 mo after treatment. The delayed heart-to-mediastinum count ratio (H/M ratio), delayed total defect score (TDS), and washout rate (WR) were determined from (123)I-meta-iodobenzylguanidine (MIBG) images. LVEF was determined by echocardiography, and New York Heart Association (NYHA) functional class was estimated.
  
  
  RESULTS
  Before treatment, LVEF, TDS, H/M ratio, WR, and NYHA functional class were similar in both groups. With treatment, LVEF did not significantly improve in either group. However, after treatment in group A, TDS decreased from 37 +/- 9 to 25 +/- 13 (P = 0.0001), H/M ratio increased from 1.62 +/- 0.20 to 1.83 +/- 0.27 (P < 0.0001), and WR decreased from 51 +/- 9 to 40 +/- 15 (P < 0.001). In group B, these parameters did not significantly change. NYHA functional class improved in both groups (in group A, from 3.3 +/- 0.5 to 1.7 +/- 0.5 [P < 0.0001]; in group B, from 3.3 +/- 0.5 to 2.4 +/- 0.6 [P = 0.01]); this was a significantly greater improvement in group A than in group B (P < 0.01).
  
  
  CONCLUSIONS
  Spironolactone improves cardiac sympathetic nerve activity and symptoms in patients with CHF.
mesh_terms: D019797:3-Iodobenzylguanidine; D000368:Aged; D000450:Aldosterone / Q000502:physiology; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D004077:Digoxin / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging / Q000294:innervation*; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000188:drug therapy*; D006801:Humans; D007457:Iodine Radioisotopes; D008297:Male; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D013148:Spironolactone / Q000627:therapeutic use*; D013318:Stroke Volume; D013564:Sympathetic Nervous System / Q000187:drug effects*
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D004232:Diuretics; D007457:Iodine Radioisotopes; D019275:Radiopharmaceuticals; D013148:Spironolactone; D019797:3-Iodobenzylguanidine; D000450:Aldosterone; D004077:Digoxin