Spironolactone improved post-exercise mean systolic myocardial velocity compared to control (9.2 vs. 8.3 cm/s, p=0.021), though benefits were attenuated in patients with ventricular dyssynchrony.
RCT (n=49)
Does spironolactone improve exercise accommodation of regional systolic myocardial velocity in patients with HFpEF?
Spironolactone improves exercise accommodation of regional systolic myocardial velocity in HFpEF patients, but this benefit is attenuated in those with ventricular dyssynchrony.
Absolute Event Rate: 9.2% vs 8.3%
p-value: p=0.021
Patients with heart failure and preserved ejection fraction (HFpEF) are known to have reduced systolic myocardial velocity (Sm) with impaired accommodation to exercise. We tested the impact of an aldosterone antagonist on Sm at rest and post-exercise. Forty-nine HFpEF patients (65 ± 11 years, 24 male) with HF signs/symptoms, mitral E/Ea (annular early diastolic velocity) > 8, and left ventricular (LV) EF > 50% were randomized to spironolactone (25 mg/day, 25 patients) or the Control. At baseline and 6 months, we analyzed Sm of basal LV segments at rest and after a 6 min treadmill exercise. At 6 months, post-exercise mean Sm in the spironolactone group became greater than that in the Control (9.2 ± 1.6 vs. 8.3 ± 1.0 cm/s, p = 0.021), mainly due to the increment of post-exercise % increase of lateral Sm (44 ± 30 vs. 30 ± 19% at baseline, p = 0.045). Further analyses showed the presence of systolic dyssynchrony (standard deviation of electromechanical delay of 6-basal LV segments > 35 ms) was independently associated with a poorer response to spironolactone, defined as a post-exercise % increase of lateral Sm < 50% (OR = 2.7, 95% CI = 1.8–4.2) and the increment of Ea < 1.5 cm/s (OR = 1.5, 95% CI = 1.1–2.3). Spironolactone could improve exercise accommodation of regional systolic myocardial velocity for HFpEF patients. However, its benefits could be decreased in those with ventricular dyssynchrony. This suggested possible therapeutic impacts from underlying heterogeneity within HFpEF patients.
Yu et al. (Thu,) conducted a rct in Heart failure with preserved ejection fraction (HFpEF) (n=49). Spironolactone vs. Control was evaluated on Post-exercise mean systolic myocardial velocity (Sm) of basal LV segments (p=0.021). Spironolactone improved post-exercise mean systolic myocardial velocity compared to control (9.2 vs. 8.3 cm/s, p=0.021), though benefits were attenuated in patients with ventricular dyssynchrony.