Mineralocorticoid receptor antagonism in acutely decompensated chronic heart failure.
OBJECTIVE
Mineralocorticoid receptor antagonist (MRA) use in acutely decompensated chronic heart failure (ADCHF) may improve congestion through diuretic effect and prevent neurohormonal activation. We aimed to evaluate the clinical effect and safety of spironolactone in ADCHF.


METHODS
Prospective, experimental, single-center, and single-blinded trial. Patients were treated with: standard ADCHF therapy or oral spironolactone 50-100mg/d plus standard ADCHF therapy.


RESULTS
During a 1year period, 100 patients were enrolled, 50 included in the treatment group. Mean (SD) spironolactone dose (mg) at day 1 was 94.5±23.3 and at day 3 was 62.7±24.3. Worsening renal function (increase in pCr≥0.3mg/dL from day 1 to day 3) was more likely to occur in control group (20% vs. 4%; p=0.038), serum potassium did not differ between groups, and plasma NTproBNP had a significant decrease in spironolactone group at day 3 (median [IQR], 2488 [4579] vs. 1555 [1832]; p=0.05). Furthermore, a greater proportion of patients in the treatment group were free of congestion at day 3: less edema, rales, jugular venous pressure (JVP) and orthopnea (all, p<0.05). In addition, a significantly higher proportion of patients were on oral furosemide at day 3 (44% vs. 82%; p<0.001).


CONCLUSIONS
Our study supports the safety of high dose spironolactone in ADCHF and suggests a positive impact in the resolution of congestion. The important findings of our pilot study need to be confirmed in larger trials.
Centro Hospitalar do Porto, Portugal. Electronic address: jp7ferreira@hotmail.com.
João Pedro
JP
Ferreira
Centro Hospitalar do Porto, Portugal.
Mário
M
Santos
Climate Change Impacts, Adaptation and Mitigation Research Group (CC-IAM), Faculdade de Ciências, Universidade de Lisboa, Portugal.
Sofia
S
Almeida
Centro Hospitalar do Porto, Portugal.
Irene
I
Marques
Centro Hospitalar de São João, Portugal.
Paulo
P
Bettencourt
Centro Hospitalar do Porto, Portugal.
Henrique
H
Carvalho
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D018450:Disease Progression; D004232:Diuretics / Q000627:therapeutic use; D004487:Edema / Q000188:drug therapy / Q000209:etiology; D005260:Female; D005665:Furosemide / Q000627:therapeutic use; D006333:Heart Failure / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use*; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011188:Potassium / Q000097:blood; D011654:Pulmonary Edema / Q000188:drug therapy / Q000209:etiology; D051437:Renal Insufficiency / Q000150:complications; D016037:Single-Blind Method; D013148:Spironolactone / Q000627:therapeutic use*; D016896:Treatment Outcome
D004232:Diuretics; D000451:Mineralocorticoid Receptor Antagonists; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D013148:Spironolactone; D005665:Furosemide; D011188:Potassium
Acute heart failure; Mineralocorticoid receptor antagonism; Natriuretic peptides