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Outcomes of Spironolactone Withdrawal in Dilated Cardiomyopathy With Improved Ejection Fraction

Yanjia Chen1,2, Zeping Qiu1,2, Jie Jiang3

  • 1Department of Vascular and Cardiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Frontiers in Cardiovascular Medicine
|October 4, 2021
PubMed

Insights

Spironolactone withdrawal in dilated cardiomyopathy patients with improved ejection fraction leads to a high relapse rate. Continued spironolactone therapy is associated with sustained cardiac function and fewer relapses.

Area of Science:

  • Cardiology
  • Pharmacology
  • Heart Failure Management

Background:

  • Spironolactone is commonly prescribed for heart failure.
  • The safety and efficacy of withdrawing spironolactone in patients with improved ejection fraction are not well-established.
  • Idiopathic dilated cardiomyopathy requires ongoing management strategies.

Purpose of the Study:

  • To assess the feasibility and safety of spironolactone withdrawal in patients with idiopathic dilated cardiomyopathy and improved left ventricular ejection fraction (LVEF).
  • To determine the rate of dilated cardiomyopathy relapse after spironolactone discontinuation.
  • To evaluate the impact of spironolactone withdrawal on cardiac structure and function.

Main Methods:

  • Prospective observational cohort study using the Risk Evaluation and Management in Heart Failure Trial database.
  • Inclusion criteria: idiopathic dilated cardiomyopathy, spironolactone prescription, and an absolute LVEF improvement ≥10% with LVEF >40%.
  • Primary endpoint: dilated cardiomyopathy relapse within 12 months, defined by LVEF reduction, LVESVi increase, NT-proBNP rise, or clinical heart failure signs.

Main Results:

  • Seventy patients were analyzed: 30 continued spironolactone, 40 withdrew.
  • The relapse rate was significantly higher in the withdrawal group (58%) compared to the continuation group (13%).
  • Withdrawal was associated with symptom aggravation and loss of cardiac structural improvements, while these were maintained in the continuation group.

Conclusions:

  • Spironolactone withdrawal in dilated cardiomyopathy patients with improved ejection fraction is associated with a high risk of relapse.
  • Continued spironolactone therapy appears crucial for maintaining cardiac function and preventing relapse in this patient population.
  • Clinical decisions regarding spironolactone withdrawal should carefully consider the potential for adverse outcomes.

Keywords:
dilated cardiomyopathyheart failure managementheart failure with improved ejection fractionspironolactonewithdrawal

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