title: Transcardiac gradient of aldosterone before and after spironolactone in patients with congestive heart failure.
abstract: To evaluate the transcardiac extraction of aldosterone before and after spironolactone administration to patients with congestive heart failure, we measured the plasma aldosterone in the aortic root and the coronary sinus in eight congestive heart failure patients with dilated cardiomyopathy. The plasma aldosterone level was significantly lower in the coronary sinus than in the aortic root before spironolactone administration (87.5 +/- 16 versus 62.2 +/- 11 pg/ml, p = 0.01). After chronic treatment with spironolactone, there was no significant difference in the aldosterone level between the aortic root and the coronary sinus (151 +/- 49 versus 148 +/- 48 pg/ml), and the transcardiac gradient of aldosterone (aortic root to coronary sinus) was significantly decreased (25.3 +/- 7.3 versus 3.1 +/- 4.5 pg/ml, p = 0.046). These results indicate that plasma aldosterone is extracted through the heart in congestive heart failure patients with dilated cardiomyopathy, and that spironolactone inhibits the transcardiac extraction of aldosterone in congestive heart failure patients. This suggests that spironolactone blocks the effects of aldosterone on the failing heart in congestive heart failure patients with dilated cardiomyopathy.
authors.affiliation: First Department of Internal Medicine, Shiga University of Medical Science, Seta, Otsu, Japan. tutamoto@belle.shiga-med.ac.jp
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Tsutamoto
authors.forename: Atsuyuki
authors.initials: A
authors.lastname: Wada
authors.forename: Keiko
authors.initials: K
authors.lastname: Maeda
authors.forename: Masaru
authors.initials: M
authors.lastname: Hayashi
authors.forename: Takashi
authors.initials: T
authors.lastname: Tsutsui
authors.forename: Masato
authors.initials: M
authors.lastname: Ohnishi
authors.forename: Masanori
authors.initials: M
authors.lastname: Fujii
authors.forename: Takehiro
authors.initials: T
authors.lastname: Matsumoto
authors.forename: Takashi
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Takayama
authors.forename: Chitose
authors.initials: C
authors.lastname: Ishii
mesh_terms: D000328:Adult; D000368:Aged; D000450:Aldosterone / Q000097:blood*; D009320:Atrial Natriuretic Factor / Q000097:blood; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010361:Patients / Q000706:statistics & numerical data; D013148:Spironolactone / Q000627:therapeutic use*
chemical_list: D020097:Natriuretic Peptide, Brain; D013148:Spironolactone; D000450:Aldosterone; D009320:Atrial Natriuretic Factor