Key result
Spironolactone 25 mg/d for 4 months in older women with diastolic heart failure increased peak exercise VO2 by 8.3% (P=.001) and decreased the E/e' ratio by 25% (P=.02).
Why the study?
Does spironolactone 25 mg/d improve exercise tolerance, diastolic function, and quality of life in older women with diastolic heart failure?
Does spironolactone 25 mg/d improve exercise tolerance, diastolic function, and quality of life in older women with diastolic heart failure?
Effect estimate: 8.3% increase
p-value: p=.001
In a small preliminary study, spironolactone 25 mg/d for 4 months significantly improved exercise capacity, diastolic function, and NYHA class in older women with diastolic heart failure.
Hypothesis-generating in this case report; larger randomized trials needed before changing practice in older women with diastolic HF.
Optimal therapy for diastolic heart failure (DHF), the most common form of heart failure in older persons, is unclear. To determine the effect of aldosterone antagonism in DHF, the authors conducted an open-label preliminary trial of spironolactone 25 mg/d in 11 women with DHF. Cardiopulmonary exercise testing, Doppler echocardiography, and a quality-of-life survey were administered at baseline and after 4 months. Peak exercise VO(2) increased by 8.3% (P=.001), the ratio of Doppler diastolic early filling velocity to mitral annulus velocity decreased by 25% (P=.02), quality-of-life score improved by 21% (P=.16 for trend), and median New York Heart Association class improved from class III to class II (P=.004). Findings from this preliminary study confirm the role of aldosterone in the pathophysiology of DHF and suggest that aldosterone antagonism may benefit such patients. These hypotheses are currently being tested in two separated National Institutes of Health-funded, randomized trials, the Spironolactone for Failure in the Elderly (SPIFFIE) and the Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist (TOPCAT) trials.
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Daniel et al. (2009) studied diastolic heart failure (n=11). spironolactone was evaluated on Peak exercise VO(2) (8.3% increase, p=.001). Spironolactone 25 mg/d for 4 months in older women with diastolic heart failure increased peak exercise VO2 by 8.3% (P=.001) and decreased the E/e' ratio by 25% (P=.02).
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