Why the study?
Despite therapeutic advances, ADHF morbidity and mortality remain poor, and early spironolactone initiation may enhance RAAS suppression to improve outcomes.
Does early spironolactone 100 mg once daily for 3 days reduce ST2 levels and improve clinical symptoms in patients hospitalized with acute decompensated heart failure?
Does early spironolactone 100 mg once daily for 3 days reduce ST2 levels and improve clinical symptoms in patients hospitalized with acute decompensated heart failure?
Early administration of high-dose spironolactone (100 mg/day for 3 days) in acute decompensated heart failure significantly reduces ST2 biomarker levels and improves clinical symptoms without increasing the risk of hyperkalemia or worsening renal function.
Early spironolactone appears safe in ADHF; extends RCT evidence for rapid RAAS blockade atop ACEI/ARB.
Background: In spite of major advances in therapy, morbidity, and mortality due to acute decompensated heart failure (ADHF) remain poor. Early initiation of mineralocorticoid antagonist (spironolactone) may increase the suppression of negative effect of renin-angiotensin-aldosterone system ( RAAS ) activation , even though it already uses ACE I /ARB accompanying ADHF and give a better outcome. This study aims to determine the effect of early spironolactone 100 mg a day for 3 consecutive days on the s uppression of tumorigenicity 2 (ST2) level and clinical changes in patients with ADHF . Subjects and Method: This was a randomized single blind controlled trial. Thirty eight conse cutive patients with ADHF hospitalized at Dr. Moewardi Hospital , Surakarta were randomized into two groups: spironolactone group (standard therapy plus spironolactone 100 mg per day for 3 day, n=19) and control group (standard therapy, n=19). Clinical sign and simptom of ADHF was monitored everyday and the difference of clinical changes was evaluated at the day-3. Venous blood samples were collected from all patients at the first day prior therapy and day-4 after therapy. The dependent variable was ST2 level . The independent variable was Spironolacton therapy . The data were analyzed by independent t-test. Results: Decreased levels of ST2 in the spironolactone group (mean= 36.96 ; SD= 21.29 ) was higher than the control group (mean= 19.73 ; SD= 16.48 ) and it was statistically significant ( p= 0 . 008). Spironolacton therapy 100 mg once daily at the first 3 day in patient with ADHF was safe, no hiperkalemia , or worsening renal function . T here was decreasing risk of hipokalemia up to 33% (RR = 0 . 33 ; 95% CI = 0 . 1 to 1 . 0; p= 0 . 036) and greater proportion patient with improvement clinical simptom and sign of ADHF at day-3 in the spironolactone group vs control group. Conclusion: Administration of spironolactone 100 mg at the first 3 day plus standard therapy decreases levels of ST2, safe, decreases risk of hipokalemia and give greater proportion of clinical improvement patients ADHF . Keywords: Spironolactone, ADHF, ST2 Correspondence: Trisulo Wasyanto . Department of Cardiology and Vascular Medicine, Faculty of Medicine, Uni versitas Sebelas Maret /Dr. Moewardi Hospital . Jl. Kol. Sutarto 132 , Surakarta 57126 . Indonesia . Email: trisulo.wasyanto@gmail.com. Indonesian Journal of Medicine (2019), 4(3): 232-240 https://doi.org/10.26911/theijmed.2019.04.03.06
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Wasyanto et al. (2019) studied this question.
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