Effect of spironolactone on cardiac sympathetic nerve activity and left ventricular remodeling in patients with dilated cardiomyopathy
Effect of spironolactone on cardiac sympathetic nerve activity and left ventricular remodeling in patients with dilated cardiomyopathy
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DOI：
10.1016/s0735-1097(02)02855-3
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发表时间：
2003-02-19
影响因子：
24
通讯作者：
Kurabayashi, M
中科院分区：
文献类型：
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作者：
Kasama, S;Toyama, T;Kurabayashi, M
我们试图评估螺内酯对扩张型心肌病（DCM）患者心脏交感神经活动和左心室（LV）重构的影响。背景醛固酮阻止去甲肾上腺素的摄取并促进心脏的结构重构。安体舒通，醛固酮受体阻滞剂，改善左心室重塑DCM患者，但其对心脏交感神经活动的影响尚未determined.METHODS我们选择了30例DCM患者谁与血管紧张素转换酶抑制剂和袢利尿剂治疗。15例患者被分配额外接受螺内酯，而其余15例患者继续其当前方案。在治疗前和治疗后6个月，通过碘-123（I31）-间碘苄胍（MIBG）图像确定延迟心脏/纵隔（H/M）计数比、延迟总缺损评分（TDS）和洗脱率（WR）。用超声心动图测定左室舒张末期容积（LVEDV）和左室射血分数（LVEF），并评价纽约心脏协会（NYHA）心功能分级（p <0.0001），H/M比从1.64 +/-0.20增加到1.86 +/-0.27（p <0.0001），WR从55 +/-12%降低到41 +/-15%（p <0.0005）。此外，LVEDV从187 ± 26降至154 ± 41（p <0.005），LVEF从33 ± 6%增至39 ± 6%（p <0.005）。然而，在对照组中这些参数没有显著变化。I-123-MIBG结果的变化与螺内酯治疗的LVEDV变化之间存在显著相关性（TDS：r = 0.684，p = 0.0038; H/M比值：r =-0.878，p <0.0001; WR：r = 0.737，p = 0.0011）。两组患者的NYHA心功能分级均有所改善，但螺内酯组的改善程度明显高于对照组（p <0.01）。结论：螺内酯可改善DCM患者的心交感神经活性和左室重构。（美国科尔心脏病学杂志2003; 41：574 - 81）（C）2003年美国心脏病学会基金会。
OBJECTIVES We sought to evaluate the effects of spironolactone on cardiac sympathetic nerve activity and left ventricular (LV) remodeling in patients with dilated cardiomyopathy (DCM).BACKGROUND Aldosterone prevents the uptake of norepinephrine and promotes structural remodeling of the heart. Spironolactone, an aldosterone receptor blocker, improves LV remodeling in patients with DCM, but its influence on cardiac sympathetic nerve activity has not been determined.METHODS We selected 30 patients with DCM who were treated with an angiotensin-converting enzyme inhibitor and a loop diuretic. Fifteen patients were assigned to receive spironolactone additionally, whereas the remaining 15 patients continued their current regimen. The delayed heart/mediastinum (H/M) count ratio, delayed total defect score (TDS), and washout rate (WR) were determined from iodine-123 (I 31)-meta-iodobenzylguanidine (MlBG) images before and six months after treatment. The left ventricular end-diastolic volume (LVEDV) and left ventricular ejection fraction (LVEF) were determined by echocardiography, and New York Heart Association (NYHA) functional class was estimated.RESULTS In the spironolactone group, the TDS decreased from 36 +/- 9 to 24 +/- 13 (p < 0.0001), the H/M ratio increased from 1.64 +/- 0.20 to 1.86 +/- 0.27 (p < 0.0001), and WR decreased from 55 +/- 12% to 41 +/- 15% (p < 0.0005). In addition, the LVEDV decreased from 187 26 to 154 +/- 41 in] (p < 0.005), and LVEF increased from 33 +/- 6% to 39 +/- 6% (p < 0.005). However, there were no significant changes in these parameters in the control group. There was a significant correlation between changes in the I-123-MIBG findings and changes in LVEDV with spironolactone treatment (TDS: r = 0.684, p = 0.0038; H/M ratio: r = -0.878, p < 0.0001; and WR: r = 0.737, p = 0.0011). The NYHA functional class improved in both groups but showed a greater improvement in the spironolactone group than in the control group (p < 0.01).CONCLUSIONS Spironolactone improves cardiac sympathetic nerve activity and LV remodeling in patients with DCM. (J Am Coll Cardiol 2003;41:574-81) (C) 2003 by the American College of Cardiology Foundation.