title: The effect of aldosterone-antagonist therapy on aortic elastic properties in patients with nonischemic dilated cardiomyopathy.
abstract: BACKGROUND
  Many studies proved the prognostic importance of aortic stiffness as an independent predictor of cardiovascular morbidity and all-cause mortality. The decrease of arterial compliance has a high prevalence in patients with heart failure and affects both hemodynamics and prognosis. Aortic stiffness is partially caused by excessive activation of the renin-angiotensin-aldosterone system. Spironolactone, a mineralcorticoid receptor antagonist (MRA), has been shown to decrease aortic stiffness and fibrosis in experimental models. However, there are few studies that describe the effects of MRA on aortic stiffness in patients with nonischemic dilated cardiomyopathy.
  
  
  OBJECTIVE
  To evaluate the effect of spironolactone on aortic stiffness in patients with nonischemic dilated cardiomyopathy.
  
  
  METHODS
  We randomized (1 : 1) 102 patients with nonischemic dilated cardiomyopathy with New York Heart Association class I-II to receive spironolactone 25 mg/day (up to 100 mg/day) or placebo, in addition to recommended therapy. Aortic stiffness index, aortic strain, aortic distensibility and aortic dimensions were assessed at baseline and after 6 months. All measures were obtained with echocardiography M-mode at 3 cm above the aortic valve on parasternal long axis view and simultaneous brachial arterial pressure with sphygmomanometer.
  
  
  RESULTS
  Ascending aorta diameters, aortic stiffness index, aortic distensibility and aortic strain were similar at randomization in the two groups. After 6 months of therapy in the treated group, we found a reduction of aortic stiffness index (7.2 ± 3.5 versus 9.6 ± 4.8 mmHg; P = 0.03) and an increase of aortic distensibility (3.77 ± 1.0 versus 2.92 ± 0.55 mmHg; P = 0.01) and systolic aortic strain (10.0 ± 5.0 versus 8.0% ± 2.1%; P = 0.01). There were no difference in systolic arterial pressure, diastolic arterial pressure and differential pressure in the two groups.
  
  
  CONCLUSIONS
  Therapy with spironolactone is effective in reducing aortic stiffness in patients with nonischemic dilated cardiomyopathy. This effect could improve hemodynamics supporting the use of MRAs in patients with low New York Heart Association class (I-II).
authors: Section of Cardiovascular Diseases, Department of Medical and Surgical, Radiological Sciences and Public Health Specialties, University of Study of Brescia, Brescia, Italy.
authors: Enrico
authors: E
authors: Vizzardi
authors: Paolo Della
authors: PD
authors: Pina
authors: Giorgio
authors: G
authors: Caretta
authors: Ivano
authors: I
authors: Bonadei
authors: Edoardo
authors: E
authors: Sciatti
authors: Carlo
authors: C
authors: Lombardi
authors: Antonio
authors: A
authors: D'Aloia
authors: Antonio
authors: A
authors: Curnis
authors: Marco
authors: M
authors: Metra
mesh_terms: D000368:Aged; D001011:Aorta / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000473:pathology / Q000503:physiopathology; D001794:Blood Pressure / Q000187:drug effects; D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D004548:Elasticity / Q000187:drug effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000494:pharmacology / Q000627:therapeutic use*; D011446:Prospective Studies; D013148:Spironolactone / Q000494:pharmacology / Q000627:therapeutic use*; D014463:Ultrasonography; D059289:Vascular Stiffness / Q000187:drug effects*
chemical_list: D000451:Mineralocorticoid Receptor Antagonists; D013148:Spironolactone