BACKGROUND: More evidence suggests that aldosterone and its signal pathway plays a important role in progression of diastolic heart failure (DHF). But aldosterone antagonists are recommended mainly for patients with moderate to severe heart failure (HF) and systolic dysfunction.
OBJECTIVES: We identify that aldosterone blockade by spironolactone improve clinical outcome and diastolic function in patients with Acute Decompensated heart failure(ADHF) and preserved systolic function.
SUBJECTS AND METHODS: In Korean acute heart failure (KorHF) registry, we analyzed 654 patients with ADHF and preserved systolicfunction. The registry enrolled the patients who were hospitalized for ADHF treatment between November 2005 and November 2009. This database included 32 tertiary medical centers from South Korea and 362 variables about the epidemiologic characteristics, management, and prognosis of patients with acute heart failure. The effect of AA was evaluated in this database. The inclusion criteria are : New York Heart Association functional class more than II, preserved left ventricular ejection fraction (≥50%), and echocardiographic evidence of diastolic dysfunction. Morbidity, readmission and mortality were assessed. The Mean follow-up period was 3.8 years.
RESULTS: In KorHF registry, 654 patients were eligible and patients with aldosterone blockade were 167 (25.5%). In both group (aldosterone antagonist use or non use), ADHF with preserved systolic function affected women more often than men. Mean ages were 69.6, 70.5 year old respectively, and there was no significant difference. Patients with aldosterone blockade had lower prevalence of diabetes, hypertension and chronic renal disease. but they had higher prevalence of valvular heart disease (especially mitral, aortic, tricuspid regurgitation). Serum BUN and Creatinine were significant lower in Aldosterone blockade group. About composite and point (readmission and death), There was no stastically significant reduction of event. In multivariated analysis, advanced age (Hazard Ratio(HR) 1.747, 95% Confidence Interval (CI) (1.079-2.830)), lower systolic blood pressure (HR 1.792, 95% CI (1.229-2.613), anemia (HR 1.909, 95% CI (1.226-2.973) were independent predictors of outcome.
CONCLUSIONS: In real clinical practice, aldosterone antagonist was used restrictively to patients with ADHF and preserved systolic function. There was no survival benefit of aldosterone blockade. But large scale randomized trial is needed to clarify the effect of this drug for diastolic heart failure.
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