Effect of spironolactone on diastolic function and exercise capacity in patients with heart failure with preserved...

Area of Science:

• Cardiology
• Internal Medicine

Background:

• Diastolic heart failure, or heart failure with preserved ejection fraction (HFpEF), is prevalent and lacks targeted therapies.
• Aldosterone may play a role in the progression of HFpEF.

Purpose of the Study:

• To evaluate the long-term efficacy and safety of aldosterone receptor blockade with spironolactone in HFpEF patients.
• To determine if spironolactone improves diastolic function and exercise capacity compared to placebo.

Main Methods:

• The Aldo-DHF trial was a randomized, double-blind, placebo-controlled study involving 422 HFpEF patients.
• Participants received either 25 mg of spironolactone or placebo daily for 12 months.
• Primary endpoints included changes in diastolic function (E/e') and maximal exercise capacity (peak VO2).

Main Results:

• Spironolactone significantly improved diastolic function (E/e') compared to placebo.
• No significant difference was observed in maximal exercise capacity (peak VO2).
• Spironolactone led to reverse cardiac remodeling and improved neuroendocrine markers but did not improve symptoms or quality of life.

Conclusions:

• Long-term aldosterone receptor blockade with spironolactone improves left ventricular diastolic function in HFpEF.
• It does not enhance maximal exercise capacity, patient-reported symptoms, or quality of life.
• The clinical relevance of improved diastolic function requires further investigation in larger cohorts.