Effect of spironolactone on plasma brain natriuretic peptide and left ventricular remodeling in patients with congestive heart failure

OBJECTIVES We sought to evaluate the effects of spironolactone on neurohumo ral factors and left ventricular remodeling in patients with congestive hea rt failure (CHF). BACKGROUND Aldosterone (ALD) promotes collagen synthesis and structural rem odeling of the heart. Spironolactone, an ALD receptor antagonist, is report ed to reduce mortality ill patients with CHF, but its influence on left ven tricular remodeling has not been clarified. METHODS Thirty-seven patients with mild-to-moderate nonischemic CI-IF were randomly divided into, two groups that received treatment with spironolacto ne (n = 20) or placebo (n = 17). We measured left ventricular volume and ma ss before treatment and after four months of treatment. We also measured th e plasma levels of neurohumoral factors, such as atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP), as well as plasma procollagen t ype III aminoterminal peptide (PIIINP), a marker of myocardial fibrosis. RESULTS Left ventricular volume and mass were significantly decreased and e jection fraction was significantly increased in the spironolactone group, w hile there were no changes in the placebo group. Plasma levels of ANP, BNP and PIIINP were significantly decreased after spironolactone treatment, but were unchanged in the placebo group. There was a significant positive corr elation between the changes of PIIINP and changes of the left ventricular v olume index (r = 0.45, p = 0.045) as well as the left ventricular mass inde x (r = 0.65, p = 0.0019) with spironolactone treatment. CONCLUSIONS These findings indicate that four months of treatment with spir onolactone improved the left ventricular volume and mass, as well as decrea sed plasma level of BNP, a biochemical marker of prognosis and/or ventricul ar hypertrophy, suggesting that endogenous aldosterone has an important rol e in the process of left ventricular remodeling in nonischemic patients wit h CHF. (J Am Coil Cardiol 2001;37:1228-33) (C) 2001 by the American College of Cardiology.