title: Effects of spironolactone treatment in elderly women with heart failure and preserved left ventricular ejection fraction.
abstract: BACKGROUND
  Although spironolactone has been shown to decrease morbidity and mortality in patients with heart failure and reduced left ventricular ejection fraction, its role in patients with heart failure and preserved left ventricular ejection fraction (HFpEF) is not well defined. In this study we investigated the mechanisms involved when elderly women with HFpEF are treated with spironolactone.
  
  
  RESULTS
  Forty-eight women with HFpEF were enrolled in a randomized placebo-controlled trial and were assigned to 25 mg spironolactone daily (n = 24) or placebo (n = 24) for 6 months. Six-minute walk distance, clinical composite score, Doppler echocardiography, and biomarkers were determined at baseline and after 3 and 6 months of therapy. Six months of spironolactone treatment stabilized clinical symptoms, as demonstrated by significant worsening of the clinical composite score in the placebo group (P = .02). In addition, spironolactone treatment improved diastolic function by significantly increasing early diastolic tissue Doppler velocity of the lateral mitral annulus (lateral e'; P = .003) and significantly reducing the mitral peak E velocity to lateral e' ratio (lateral E/e'; P = .0001). Finally, spironolactone favorably affected remodeling through a reduction in myocardial fibrosis measured by a reduction in type III procollagen levels (P = .035). Six-minute walk distance did not significantly improve with spironolactone treatment compared with placebo.
  
  
  CONCLUSIONS
  Spironolactone stabilizes functional capacity and symptoms and improves diastolic function, possibly through its ability to suppress type III procollagen synthesis.
authors.affiliation: Methodist DeBakey Heart and Vascular Center, Department of Cardiology, Houston, Texas. Electronic address: kkurrelmeyer@houstonmethodist.org.
authors.forename: Karla M
authors.initials: KM
authors.lastname: Kurrelmeyer
authors.affiliation: Houston Hospital Research Institute, Houston, Texas.
authors.forename: Yelena
authors.initials: Y
authors.lastname: Ashton
authors.affiliation: Houston Hospital Research Institute, Houston, Texas.
authors.forename: Jiaqiong
authors.initials: J
authors.lastname: Xu
authors.affiliation: Methodist DeBakey Heart and Vascular Center, Department of Cardiology, Houston, Texas.
authors.forename: Sherif F
authors.initials: SF
authors.lastname: Nagueh
authors.affiliation: Methodist DeBakey Heart and Vascular Center, Department of Cardiology, Houston, Texas.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Torre-Amione
authors.affiliation: Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Department of Cardiology, Houston, Texas.
authors.forename: Anita
authors.initials: A
authors.lastname: Deswal
mesh_terms: D000368:Aged; D003971:Diastole; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D000451:Mineralocorticoid Receptor Antagonists / Q000008:administration & dosage; D012189:Retrospective Studies; D013148:Spironolactone / Q000008:administration & dosage*; D013318:Stroke Volume / Q000187:drug effects / Q000502:physiology*; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000187:drug effects / Q000502:physiology*
chemical_list: D000451:Mineralocorticoid Receptor Antagonists; D013148:Spironolactone
keywords: Heart failure; biomarkers; clinical trials; diastolic function; spironolactone