title: Effects of spironolactone on ventricular-arterial coupling in patients with chronic systolic heart failure and mild symptoms.
abstract: BACKGROUND
  Several studies demonstrated that mineralocorticoid receptor antagonists (MRAs) are able to prevent myocardial and vascular fibrosis, and left ventricular (LV) remodeling in patients with systolic chronic heart failure (HF) and mild symptoms. Ventricular-arterial coupling (VAC) should be influenced by anti-fibrotic interventions. We have assessed the effects of spironolactone on VAC and its components, aortic elastance (Ea) and end-systolic LV elastance (Ees), in patients with HF.
  
  
  RESULTS
  Changes from baseline in VAC were compared between 65 patients treated with spironolactone and 32 controls not receiving MRAs. All patients had HF, reduced LVEF with reduced LV ejection fraction (LVEF) and New York Heart Association (NYHA) functional class I-II symptoms, and underwent transthoracic echocardiography at baseline and after 6 months. VAC was estimated by the modified single-beat method as Ea/Ees. Parameters of LV function improved after 6 month treatment with spironolactone with an increase in the LVEF from 34 ± 8 to 39 ± 8 % (p < 0.001). Spironolactone increased Ees from 1.32 ± 0.38 to 1.57 ± 0.42 mmHg/mL (p < 0.001) and reduced VAC from 2.03 ± 0.59 to 1.66 ± 0.31 (p < 0.001), but did not affect Ea and V0 (LV volume at end-systolic pressure of 0 mmHg). No change in any of these parameters occurred in the control group.
  
  
  CONCLUSIONS
  6-month therapy with spironolactone improved VAC mainly through its effect on Ees in patients with mild HF.
authors.affiliation: Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Study of Brescia, Brescia, Italy. enrico.vizzardi@tin.it.|, Piazzale Spedali Civili 1, 25123, Brescia, Italy. enrico.vizzardi@tin.it.
authors.forename: Enrico
authors.initials: E
authors.lastname: Vizzardi
authors.affiliation: Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Study of Brescia, Brescia, Italy.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Sciatti
authors.affiliation: Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Study of Brescia, Brescia, Italy.
authors.forename: Ivano
authors.initials: I
authors.lastname: Bonadei
authors.affiliation: Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Study of Brescia, Brescia, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: D'Aloia
authors.affiliation: Cardiac Rehabilitation, Léon Bérard Hospital, Hyères, France.|Cardiology Department, Sainte Musse Hospital, Toulon, France.
authors.forename: Lamia
authors.initials: L
authors.lastname: Tartière-Kesri
authors.affiliation: Cardiology Department, Sainte Musse Hospital, Toulon, France.|INSERM U942, Paris, France.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Tartière
authors.affiliation: Cardiology Department, Lariboisière Hospital and Denis Diderot University, Paris, France.|INSERM U942, Paris, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Cohen-Solal
authors.affiliation: Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Study of Brescia, Brescia, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Metra
mesh_terms: D000368:Aged; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D054143:Heart Failure, Systolic / Q000188:drug therapy* / Q000503:physiopathology; D006352:Heart Ventricles / Q000503:physiopathology; 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*; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy* / Q000503:physiopathology; D016277:Ventricular Function, Left / Q000187:drug effects; D020257:Ventricular Remodeling / Q000187:drug effects
chemical_list: D000451:Mineralocorticoid Receptor Antagonists; D013148:Spironolactone
keywords: Heart failure; Mineralocorticoid receptor antagonists; Modified single-beat method; Ventricular-arterial coupling