Key result
Adding spironolactone to metoprolol is linked to a ~30% higher clinical response rate in CAD-associated HF.
Why the study?
The effect of metoprolol combined with spironolactone on cardiac function in patients with coronary heart disease complicated by heart failure required evaluation.
Does metoprolol combined with spironolactone improve cardiac function and clinical efficacy compared to metoprolol alone in patients with coronary heart disease complicated by heart failure?
Cohort (n=100)
No
Does metoprolol combined with spironolactone improve cardiac function and clinical efficacy compared to metoprolol alone in patients with coronary heart disease complicated by heart failure?
Absolute Event Rate: 90.74% vs 69.56%
p-value: p=0.007
The addition of spironolactone to metoprolol significantly improves cardiac function, reduces inflammation, and enhances overall clinical efficacy in patients with heart failure complicating coronary heart disease.
May support adding spironolactone to metoprolol in CHD with HF; leaves open confirmation by randomized trials.
OBJECTIVE: To evaluate the effect of metoprolol combined with spironolactone on cardiac function in patients with coronary heart disease (CHD) complicated by heart failure. METHODS: The study involved 123 patients with CHD and heart failure treated at Anqing Shihua Hospital of Nanjing Drum Tower Hospital Group between February 2022 and May 2024. After applying the inclusion and exclusion criteria, 100 cases were finally selected. The patients were divided into two groups: the control group (CG, 46 patients), receiving metoprolol monotherapy, and the research group (RG, 54 patients), receiving metoprolol combined with spironolactone. Cardiac function indicators, including left ventricular ejection fraction (LVEF), left ventricular end-systolic diameter (LVESd), and left ventricular end-diastolic diameter (LVEDd), were assessed before and after treatment. Additionally, changes in B-type natriuretic peptide (BNP) and C-reactive protein (CRP), cardiac index, and cardiac output were analyzed. The clinical treatment efficacy was also analyzed. Logistic regression analysis was used to identify the risk factors influencing treatment outcomes. RESULTS: Following treatment, both groups showed significant improvements in LVEF (P<0.05) and reductions in LVESd and LVEDd (P<0.05). The RG demonstrated significantly greater improvements in LVEF and more pronounced reductions in LVESd and LVEDd compared to the CG (P<0.05). BNP and CRP levels significantly decreased in both groups (P<0.05), with the RG showing significantly lower levels than the CG (P<0.05). Both cardiac index and cardiac output increased significantly in both groups (P<0.05), with the RG demonstrating notably higher values than the CG (P<0.05). The total effective rate was 69.56% in the CG, significantly lower than 90.74% in the RG (P<0.05). Logistic regression identified age, duration of heart failure, and treatment method as independent risk factors influencing the treatment outcomes (all P<0.05). CONCLUSION: Metoprolol combined with spironolactone significantly improves cardiac function, reduces inflammation, and enhances cardiac performance in patients with CHD complicated by heart failure.
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Mingfang Jiang (2025) conducted a cohort in Coronary heart disease complicated by heart failure (n=100). Metoprolol combined with spironolactone vs. Metoprolol monotherapy was evaluated on Total effective rate (based on NYHA cardiac function classification improvement) (p=0.007). Metoprolol combined with spironolactone significantly increased the total clinical effective rate to 90.74% compared to 69.56% with monotherapy in patients with coronary heart disease complicated by heart failure.
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