Features of cardiovascular remodeling, the level of neurohumoral factors depending on the degree of chronic heart failure and kidney dysfunction

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

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.