RT Journal Article
SR Electronic
T1 Effects of spironolactone on cardiac sympathetic nerve activity and left ventricular remodelling after reperfusion therapy in patients with first ST-segment elevation myocardial infarction
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 817
OP 822
DO 10.1136/hrt.2010.215459
VO 97
IS 10
A1 Kasama, Shu
A1 Toyama, Takuji
A1 Sumino, Hiroyuki
A1 Kumakura, Hisao
A1 Takayama, Yoshiaki
A1 Minami, Kazutomo
A1 Ichikawa, Shuichi
A1 Matsumoto, Naoya
A1 Sato, Yuichi
A1 Kurabayashi, Masahiko
YR 2011
UL http://heart.bmj.com/content/97/10/817.abstract
AB 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.