Effect of large dosage of spironolactone on cardiac function and plasma level of brain natriuretic peptide in elderly patients with chronic heart failure / 中华老年医学杂志

ABSTRACT

Objective To investigate the effect of large dosage of spironolactone on cardiac function and plasma level of brain natriuretic peptide (BNP) in elderly patients with chronic heart failure (CHF).Methods Totally 68 cases with CHF (NYHA cardiac function class Ⅲ and Ⅳ) were randomly divided into study group (with adding spironolactone 20 mg/d and 60 mg/d to conventional treatment,n =34) and control group (conventional treatment,n =34).The cardiac function and plasma level of BNP were evaluated after 6 months treatment.Results The post-treatment plasma level of BNP dropped from ( 921.4 + 284.5) ng/L to ( 316.4 ± 193.3 ) ng/L in study group (t=14.722,P=0.000) and from (904.3 + 274.0) ng/L to (481.3 ± 202.5) ng/L in control group (t=9.271,P=0.000) with significant difference in posttreatment BNP level between two groups (t=4.280,P=0.011).The values of left ventricular ejection fraction (LVEF) were higher after treatment than before treatment in study group[(32.2 + 4.7) ％ vs.(45.1 + 6.2) ％,t =6.820,P=0.004]and in control group[(31.8±5.1) ％ vs.(38.3+5.7)％,t=5.283,P=0.008],and the post-treatment LVEF was much higher in study group than in control group (t=3.844,P=0.017).The value of left ventricular end diastolic diameter (LVEDD) dropped significantly after treatment as compared to before treatment in study group[(58.6±4.4) mm vs.(45.7±4.4) mm,t =5.822,P=0.006]and in control group[(59.1±5.2) mm vs.(52.4±4.8) mm,t=3.018,P=0.024],and there was remarkable difference in LVEDD value between the two groups after treatment (t=3.393,P=0.020).The cardiac function after treatment was markedly improved as compared to before treatment in study group (x2=5.527,P=0.009) and in control group (x2=4.180,P=0.013),and the study group showed a more satisfactory result than control group (x2 =3.273,P=0.022).The incidence of side effects were 11.76％ in the study group and 8.82％ in control group with no significant difference (P=0.116).Conclusions Large dosage of spironolactone added to the conventional therapy may significantly improve cardiac function and decrease plasma BNP,especially for the elderly patients with severe CHF.