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Acute coronary syndromes
Effects of spironolactone on cardiac sympathetic nerve activity and left ventricular remodelling after reperfusion therapy in patients with first ST-segment elevation myocardial infarction
  1. Shu Kasama1,2,
  2. Takuji Toyama1,
  3. Hiroyuki Sumino2,
  4. Hisao Kumakura2,
  5. Yoshiaki Takayama2,
  6. Kazutomo Minami2,
  7. Shuichi Ichikawa2,
  8. Naoya Matsumoto3,
  9. Yuichi Sato4,
  10. Masahiko Kurabayashi1
  1. 1Department of Medicine and Biological Science (Cardiovascular Medicine), Gunma University Graduate School of Medicine, Gunma, Japan
  2. 2Department of Cardiology, Cardiovascular Hospital of Central Japan (Kitakanto Cardiovascular Hospital), Gunma, Japan
  3. 3Department of Cardiology, Nihon University School of Medicine, Tokyo, Japan
  4. 4Department of Imaging, Health Park Clinic, Takasaki, Gunma, Japan
  1. Correspondence to Dr Shu Kasama, Department of Medicine and Biological Science (Cardiovascular Medicine), Gunma University Graduate School of Medicine, 3-39-15, Showa-machi, Maebashi, Gunma 371-0034, Japan; s-kasama{at}bay.wind.ne.jp

Abstract

Objective To evaluate the effects of spironolactone on cardiac sympathetic nerve activity (CSNA) and left ventricular (LV) remodelling in patients with ST-segment elevation myocardial infarction (STEMI).

Design Single-centre, prospective, randomised evaluation study.

Setting Patients with a first STEMI and single-vessel disease undergoing primary coronary angioplasty.

Patients Sixty patients randomly assigned to two groups before angioplasty.

Interventions Patients were randomly assigned to receive or not the spironolactone before primary coronary angioplasty.

Main outcome The extent score (ES) was determined by use of 99mTc-pyrophosphate scintigraphy to evaluate the area of initial myocardial damage 3–5 days after primary angioplasty. The LV end-diastolic volume (LVEDV), LV end-systolic volume (LVESV) and LV ejection fraction were determined by echocardiography, and plasma procollagen type III aminoterminal peptide (PIIINP) was measured before and 3 weeks after treatments. The delayed heart/mediastinum count (H/M) ratio, delayed total defect score (TDS) and washout rate (WR) were determined from 123I-meta-iodobenzylguanidine scintigraphy after 3 weeks.

Results After primary angioplasty, age, gender, risk factors, culprit coronary artery, peak serum creatine kinase concentration, recanalisation time and ES were similar in the two groups. However, in the spironolactone group, the TDS and WR were significantly lower (TDS: mean (SD) 22.5 (8.0) vs 29.5 (10.1), p<0.005, WR: 30.5 (8.7)% vs 40.0 (10.9)%, p<0.001) and the H/M ratio was significantly higher (2.18 (0.37) vs 1.96 (0.30), p<0.05) than in the non-spironolactone group. Moreover, significant correlations were found between the degree of change in PIIINP concentration and change in LVEDV (r=0.559, p=0.001), or LVESV (r=0.546, p=0.002) in the spironolactone group.

Conclusion Administration of spironolactone improves CSNA and prevents LV remodelling in patients with a first STEMI.

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Footnotes

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the ethics committee at the Cardiovascular Hospital of Central Japan.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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