title: 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.
abstract: 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.
authors.affiliation: Department of Cardiology, Ospedale S Croce-Carle, Cuneo, Italy. m_feola@virgilio.it
authors.forename: Mauro
authors.initials: M
authors.lastname: Feola
authors.forename: Endrj
authors.initials: E
authors.lastname: Menardi
authors.forename: Flavio
authors.initials: F
authors.lastname: Ribichini
authors.forename: Antonello
authors.initials: A
authors.lastname: Vado
authors.forename: Antonello
authors.initials: A
authors.lastname: Deorsola
authors.forename: Valerie
authors.initials: V
authors.lastname: Ferrero
authors.forename: Gianluca
authors.initials: G
authors.lastname: Visconti
authors.forename: Ugo
authors.initials: U
authors.lastname: Milanese
authors.forename: Eugenio
authors.initials: E
authors.lastname: Uslenghi
mesh_terms: 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*
chemical_list: D000959:Antihypertensive Agents; D002316:Cardiotonic Agents; D004232:Diuretics; D000451:Mineralocorticoid Receptor Antagonists; D020097:Natriuretic Peptide, Brain; D013148:Spironolactone