Effects of spironolactone and eplerenone on left ventricular diastolic function and neurohumoral factors in patients with heart failure

Abstract

Aim. To study the effects of spironolactone and eplerenone on left ventricular diastolic function and neurohumoral factors in patients with heart failure (HF).Material and methods. We examined 131 patients with coronary artery disease and NYHA class I-III HF. Patients were randomized into groups depending on HF class: class I (n=31), class II (n=51) and class III (n=49).Results. The study revealed that the clinical course of HF and LV diastolic dysfunction are associated with an increased level of neurohormones and are characterized by significantly high levels of aldosterone and norepinephrine in patients with a restrictiveLV diastolic dysfunction. A correlation was found between the level of neurohormones (aldosterone and norepinephrine) and heart remodeling parameters: an inverse correlation with an ejection fraction (r=-0,68, r=-0,61, respectively) and a direct correlation with LV end-diastolic volume (r=0,58, r=0,66, respectively). Long-term treatment with spironolactone and eplerenone had a positive effect, reducing the level of mentioned neurohormones. In patients with class II HF, both drugs had a positive effect on the level of aldosterone and norepinephrine, reducing them by 26,6% and 20,2% in the spironolactone group and by 28,4% and 24,6% in the eplerenone group, respectively. In patients with class III HF, the decrease in aldosterone level was more pronounced in those taking eplerenone than spironolactone: 32,1% vs 20,2%, respectively.Conclusion. In patients with HF, combination therapy with the inclusion of spironolactone significantly reduced the level of neurohormones mainly in patients with class II HF and, to a lesser extent, in those with class III HF. This suggests that combination therapy with spironolactone is less effective than with eplerenone in relation to neurohormones’ levels.