Effect of spironolactone on cardiacsympathetic nerve activity and left ventricular remodeling in patients with dilated cardiomyopathy

Kasama, Shu; Toyama, Takuji; Kumakura, Hisao; Takayama, Yoshiaki; Ichikawa, Shûichi; Suzuki, Tadashi; Kurabayashi, Masahiko

doi:10.1016/s0735-1097(02)02855-3

Cited by 144 publications

(93 citation statements)

References 31 publications

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“…Standard life-prolonging neurohormonal blockers for CHF, including ACEIs, ARBs, beta-blockers and aldosterone antagonists, have been shown to improve HRV parameters in patients with CHF (25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36), and the success in treating CHF by pharmacological neurohumoral antagonists underscores the importance of modulating the neurohumoral axis to improve clinical outcome (37,38).…”

Section: Discussionmentioning

confidence: 99%

The preserved autonomic functions may provide the asymptomatic clinical status in heart failure despite advanced left ventricular systolic dysfunction

Kocaman

Taçoy²,

Özdemir³

et al. 2010

Anadolu Kardiyol Derg

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Objective: Autonomic dysfunction is an important marker of prognosis in congestive heart failure (CHF) and may determine the symptoms and progression of CHF. The aim of our study was to investigate whether preserved autonomic function assessed by heart rate variability (HRV) analyses is related to absence of CHF symptoms despite prominently reduced systolic function. Methods: The study had a cross-sectional observational design. Fifty patients with left ventricular ejection fraction (EF) below 40% were enrolled. The patients were divided into two groups according to their CHF symptomatic status as Group 1 (NYHA functional class I, asymptomatic group) and Group 2 (NYHA functional class≥ II, symptomatic group). Plasma C-reactive protein (CRP), N-terminal proB-type natriuretic peptide (NT-proBNP) levels, echocardiographic parameters and HRV indices were measured while the patients were clinically stable in each group. Possible factors associated with the development of CHF symptoms were assessed by using multiple regression analysis. Results: Baseline clinical characteristics and left ventricular EF were similar in the two groups. Serum CRP (15±21 vs 7±18 mg/L, p=0.011) and NT-proBNP levels (1935±1088 vs 1249±1083 pg/mL, p=0.020) were significantly higher in symptomatic group. The HRV parameters (SDNN: 78±57 vs 122±42 ms, p=0.001; SDANN: 65±55 vs 84±38 ms, p=0.024; SDNNi: 36±41 vs 70±46 ms, p<0.001; triangular index [Ti]: 17±12 vs 32±14, p<0.001) were also significantly depressed in symptomatic group. When multiple regression analysis was performed, only HRV indices of autonomic function were significantly associated with the asymptomatic status (SDNN, OR: 1.016, 95%CI: 1.002-1.031, p=0.028; SDNNi, OR: 1.030, 95%CI: 1.008-1.052, p=0.006; TI, OR: 1.088, 95%CI: 1.019-1.161, p=0.011). Conclusion: Preserved autonomic functions were shown to be associated with absence of CHF symptoms independently of angiotensin converting enzyme inhibitor/angiotensin receptor blocker's treatment and BNP levels and may be protective against the development of CHF symptoms despite advanced left ventricular systolic dysfunction. (Anadolu Kardiyol Derg 2010 December 1; 10(6); 519-25) Key words: Heart rate variability, systolic heart failure, preserved autonomic function, autonomic dysfunction, clinical symptoms, regression analysis ÖZET Amaç: Otonomik disfonksiyon konjestif kalp yetersizliğinde (KKY) prognozun önemli bir belirleyicisidir ve KKY'nin semptomlarını ve ilerlemesini öngörebilir. Çalışmamızın amacı belirgin olarak azalmış sistolik fonksiyonu olan hastalarda kalp hızı değişkenliği (KHD) ile belirlenen korunmuş otonomik fonksiyonun KKY semptomlarının yokluğu ile ilişkili olup olmadığının araştırılmasıdır. Yöntemler: Çalışma gözlemsel ve enine-kesitli olarak planlandı. Sol ventrikül ejeksiyon fraksiyonu (EF) %40'ın altında 50 hasta çalışmaya alındı. Hastalar KKY semptomatik durumlarına göre; Grup 1 (NYHA sınıf I, asemptomatik grup) ve Grup 2 (NYHA sınıf>=II, semptomatik grup) olmak üzere iki gruba ayrıldılar. Hastaların p...

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Section: Discussionmentioning

confidence: 99%

The preserved autonomic functions may provide the asymptomatic clinical status in heart failure despite advanced left ventricular systolic dysfunction

Kocaman

Taçoy²,

Özdemir³

et al. 2010

Anadolu Kardiyol Derg

View full text Add to dashboard Cite

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“…In one group, the delayed H/M ratio ranged from 2.1 to 2.4, using LEHR or LEGP collimators [7,14,24,25]. Another group showed a comparatively higher delayed H/M ratio, from 2.8 to 3.0. using ME collimator or LME collimator [9,11].…”

Section: Clinical Significancementioning

confidence: 96%

Standardization of the heart-to-mediastinum ratio of 123I-labelled-metaiodobenzylguanidine uptake using the dual energy window method: feasibility of correction with different camera–collimator combinations

Matsuo

Nakajima

Okuda

et al. 2008

Eur J Nucl Med Mol Imaging

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“…Therefore, it is highly desirable to establish a method to appropriately identify patients who will exhibit a sufficient response and can tolerate contemporary drug therapy beyond physician preference or experience. Although only a few studies on this topic have been conducted (11,(37)(38)(39)(40)(41)(42)(43)(44)(45)(46), cardiac 123 I-MIBG imaging can be used to monitor the effects of treatment with b-blocking agents, renin-angiotensin-aldosterone inhibitors, or their combinations by correlating an increase in cardiac 123 I-MIBG activity (HMR) and a decrease in 123 I-MIBG WR with an improvement in NYHA functional class, LVEF, or exercise tolerance.…”

Section: Pharmacologic Treatment and Cardiac 123 I-mibg Imagingmentioning

confidence: 99%

Cardiac ¹²³I-MIBG Imaging for Clinical Decision Making: 22-Year Experience in Japan

Nakajima

Nakata

2015

J Nucl Med

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Cardiac neuroimaging with 123 I-metaiodobenzylguanidine ( 123 I-MIBG) has been officially used in clinical practice in Japan since 1992. The nuclear cardiology guidelines of the Japanese Circulation Society, revised in 2010, recommended cardiac 123 I-MIBG imaging for the management of heart failure (HF) patients, particularly for the assessment of HF severity and prognosis of HF patients. Consensus in North American and European countries regarding incorporation into clinical practice, however, has not been established yet. This article summarizes 22 y of clinical applications in Japan of 123 I-MIBG imaging in the field of cardiology; these applications are reflected in cardiology guidelines, including recent methodologic advances. A standardized cardiac 123 I-MIBG parameter, the heartto-mediastinum ratio (HMR), is the basis for clinical decision making and enables common use of parameters beyond differences in institutions and studies. Several clinical studies unanimously demonstrated its potent independent roles in prognosis evaluation and risk stratification irrespective of HF etiologies. An HMR of less than 1.6−1.8 and an accelerated washout rate are recognized as high-risk indicators of pump failure death, sudden cardiac death, and fatal arrhythmias and have independent and incremental prognostic values together with known clinical variables, such as left ventricular ejection fraction and brain natriuretic peptide. Another possible use of this imaging technique is the selection of therapeutic strategy, such as pharmacologic treatment and nonpharmacologic treatment with an implantable cardioverter-defibrillator or cardiac resynchronization device; however, this possibility remains to be investigated. Recent multiple-cohort database analyses definitively demonstrated that patients who were at low risk for lethal events and who were defined by an HMR of greater than 2.0 on 123 I-MIBG studies had a good long-term prognosis. Future investigations of cardiac 123 I-MIBG imaging will contribute to better risk stratification of low-risk and high-risk populations, to the establishment of costeffective use of this imaging technique for the management of HF patients, and to worldwide acceptance of this imaging technique in clinical cardiology practice.

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Effect of spironolactone on cardiacsympathetic nerve activity and left ventricular remodeling in patients with dilated cardiomyopathy

Abstract: Spironolactone improves cardiac sympathetic nerve activity and LV remodeling in patients with DCM.

Cited by 144 publications

References 31 publications

The preserved autonomic functions may provide the asymptomatic clinical status in heart failure despite advanced left ventricular systolic dysfunction

The preserved autonomic functions may provide the asymptomatic clinical status in heart failure despite advanced left ventricular systolic dysfunction

Standardization of the heart-to-mediastinum ratio of 123I-labelled-metaiodobenzylguanidine uptake using the dual energy window method: feasibility of correction with different camera–collimator combinations

Cardiac ¹²³I-MIBG Imaging for Clinical Decision Making: 22-Year Experience in Japan

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Effect of spironolactone on cardiacsympathetic nerve activity and left ventricular remodeling in patients with dilated cardiomyopathy

Abstract: Spironolactone improves cardiac sympathetic nerve activity and LV remodeling in patients with DCM.

Cited by 144 publications

References 31 publications

The preserved autonomic functions may provide the asymptomatic clinical status in heart failure despite advanced left ventricular systolic dysfunction

The preserved autonomic functions may provide the asymptomatic clinical status in heart failure despite advanced left ventricular systolic dysfunction

Standardization of the heart-to-mediastinum ratio of 123I-labelled-metaiodobenzylguanidine uptake using the dual energy window method: feasibility of correction with different camera–collimator combinations

Cardiac 123I-MIBG Imaging for Clinical Decision Making: 22-Year Experience in Japan

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Cardiac ¹²³I-MIBG Imaging for Clinical Decision Making: 22-Year Experience in Japan