[Effect of spironolactone on left ventricular remodeling in patients with acute myocardial infarction].
OBJECTIVE
To investigate the effect of spironolactone on left ventricular remodeling (LVRM) in patients with acute myocardial infarction.


METHODS
In this multicentric, randomized, controlled study, spironolactone 40 mg/d was randomly administered in addition to the routine treatment for patients with AMI. During the 6 months the serum PIIINP, BNP and echocardiography were examined in all patients to assess myocardial fibrosis, LV function and volume.


RESULTS
A total of 88 AMI patients entered the study came from 4 hospitals in Shijiazhuang. There were 43 patients with anterior MI and 45 with inferior MI. In anterior MI group 23 patients received spironolactone and 20 accepted the routine treatment. In inferior MI group 23 received spironolactone and 22 accepted the routine treatment. In anterior MI group: (1) At 3rd, 6th month PIIINP and BNP serum levels were significantly lower in the spironolactone group compared with those in control group [PIIINP (260.2 +/- 59.9) vs (328.0 +/- 70.3) ng/L, P = 0.001, (197.1 +/- 46.3) vs (266.7 +/- 52.4) ng/L, P < 0.001], [BNP (347.4 +/- 84.0) vs (430.1 +/- 62.9) ng/L, P < 0.001, (243.7 +/- 79.7) vs (334.6 +/- 62.8) ng/L, P < 0.001]; (2) There were smaller LVEDD and LVESD in spironolactone group compared with those in control group after 6 months intervention [(51.0 +/- 5.5) vs (55.6 +/- 4.5) mm, P = 0.005, (35.7 +/- 4.6) vs (39.1 +/- 5.6) mm, P = 0.046]. However, in inferior MI group: (1) There were no significant differences in PIIINP and BNP values between the two groups after 6 months intervention; (2) There were no significant differences in the LVEDD, LVESD, LVEF after 6 months treatment.


CONCLUSIONS
(1) In patients with anterior MI, spironolactone combined with the routine treatment could inhibit myocardial fibrosis and left ventricular dilation and prevent LVRM. (2) In patients with inferior MI, no significant difference in prevention of LVRM was found between the spironolactone combined with the routine treatment and the routine treatment alone.
Dong
Qi
Q
Department of Cardiology, The First Hospital of Hebei Medical University, Shijiazhuang 050031, China. hsylyf@tom.com
Liu
Kun-shen
KS
Liu
Hong-bin
HB
Li
Shu-ren
SR
Han
Yu-ping
YP
Zhang
Lu-ping
LP
Wang
Ying
Y
Liu
Gang
G
Wang
Xiao-ping
XP
Xu
Li-fei
LF
Li
Xiu-cai
XC
D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000503:physiopathology; D009204:Myocardial Revascularization; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011347:Procollagen / Q000097:blood; D013148:Spironolactone / Q000627:therapeutic use*; D020257:Ventricular Remodeling / Q000187:drug effects*
D010446:Peptide Fragments; D011347:Procollagen; C041876:procollagen Type III-N-terminal peptide; D020097:Natriuretic Peptide, Brain; D013148:Spironolactone