Effects of the addition of a low dose of spironolactone on brain natriuretic peptide plasma level and cardiopulmonary function in patients with moderate congestive heart failure.
BACKGROUND
The purpose of our study was to assess the effects of a low dose of spironolactone in patients with moderate congestive heart failure (CHF) on the plasma level of brain natriuretic peptide (BNP), echocardiographic left ventricular ejection fraction (LVEF), and cardiopulmonary function assessed by cardiopulmonary (CP) test.


METHODS
51 CHF patients (74.5% males, mean age 60 years) underwent transthoracic echocardiography, CP test, and plasma BNP assay at the time of enrollment and after 6 months of standard therapy for CHF plus a low dose of spironolactone (group A). A control group (21 patients, group B) was treated using standard therapy only. All subjects were in NYHA class I-III and had LVEF < or = 40%.


RESULTS
BNP concentration decreased significantly (from 45.7+/-57.4 pg/ml to 18.6+/-26.9 pg/ml at follow-up; p=0.01), and the NYHA class and LVEF improved (2.2+/-0.6 vs 1.7+/-0.5, p=0.0001; 27.7+/-7.2% vs 35.1+/-11%, p=0.001 respectively) in subjects in group A. In spite of clinical amelioration, peak oxygen consumption, oxygen pulse and anaerobic threshold in the CP test did not change significantly (16.6+/-5.7 ml/kg/min vs 17.1+/-5.3 ml/kg/min p=0.5; 8.8 +/- 4.3 ml/beat vs 9.5+/-3.6 ml/beat p=0.2; 0.75+/-0.2 ml/Kg/min vs 0.73+/-0.2 ml/Kg/min p=0.7). No differences were noticed in the control group.


CONCLUSIONS
The addition of spironolactone reduced the BNP plasma level in patients with moderate CHF and increased LVEF. This therapy improved the NYHA class without modifying the functional parameters in the CP test.
Feola
Mauro
M
Department of Cardiology, Ospedale S Croce-Carle, Cuneo, Italy. m_feola@virgilio.it
Menardi
Endrj
E
Ribichini
Flavio
F
Vado
Antonello
A
Deorsola
Antonello
A
Ferrero
Valerie
V
Visconti
Gianluca
G
Milanese
Ugo
U
Uslenghi
Eugenio
E
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002316:Cardiotonic Agents / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D004452:Echocardiography; D006333:Heart Failure / Q000097:blood / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use*; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D013148:Spironolactone / Q000627:therapeutic use*; D016277:Ventricular Function, Left / Q000502:physiology*
D000959:Antihypertensive Agents; D002316:Cardiotonic Agents; D004232:Diuretics; D000451:Mineralocorticoid Receptor Antagonists; D020097:Natriuretic Peptide, Brain; D013148:Spironolactone