Modification of ventriculo–arterial coupling by spironolactone in nonischemic dilated cardiomyopathy

Lawson, Mark A.; Hansen, David E.; Gupta, Deepak K.; Bell, Susan P.; Adkisson, Douglas W.; Mallugari, Ravinder; Sawyer, Douglas B.; Ooi, Henry; Kronenberg, Marvin W.

doi:10.1002/ehf2.13161

Cited by 5 publications

(3 citation statements)

References 51 publications

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“…[20] This outcome can indicate and emphasize the conclusion that HA is a reversible factor of heart remodeling and must be cured. MRA also turned out to improve LVEF [21] and reduce peripheral vascular disease due to arterial elastance improvement and inhibition of myocardial collagen synthesis. [22] The significance of the presence of HA stands in contrast to the results from the other research, which was mentioned above.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the pharmacotherapeutic impact on contractility recovery in patients with newly diagnosed, acute onset dilated cardiomyopathy

Orszulak,

Baasansuren,

Balwierz

et al. 2023

Medicine

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In patients with acute onset dilated cardiomyopathy (DCM) an improvement of left ventricular ejection fraction (LVEF) can occur as an effect of complex therapy. The aim of the study was to evaluate a pharmacotherapeutic impact on LVEF recovery in newly diagnosed DCM heart failure (HF) patients. A total of 2436 patients hospitalized due to acute decompensated HF were retrospectively analyzed. Finally, 24 patients with newly diagnosed DCM (51.4 ± 16.3 years, New York Heart Association 2.3 ± 0.7, LVEF 25 ± 10%) were observed (13.4 ± 16.0 months) in terms of the result of complex therapy. Patients were divided according to LVEF improvement on follow-up echocardiography: "recovery group" (LVEF improvement > 5%; n = 13) and "nonrecovery group" (∆LVEF ≤ 5%; n = 11). Evaluation of baseline parameters showed lower LVEF (19 ± 6 vs 31 ± 10%; P = .0048) and lower incidence of arterial hypertension (27% vs 73%; P = .043) in "recovery" group. After follow-up period LVEF was similar in both groups; however, significant LVEF improvement was demonstrated only in the "recovery group" (19 ± 6% to 34 ± 8%; P < .001). Only the "recovery group" showed significant HF symptoms reduction (New York Heart Association class: 2.5 ± 0.7 to 1.6 ± 0.6; P = .003). The "recovery group" had prescribed higher doses of loop diuretic (equivalent dose of furosemidum: 80 ± 38 mg vs 43 ± 24 mg; P = .025). Despite optimal therapy, significant LVEF improvement is observed only in the half of the patients with newly diagnosed DCM with HF with reduced EF. Prescription of higher doses of loop diuretics may have positive effect on the reduction of symptoms in newly diagnosed DCM HF patients. Lack of other risk factors such as arterial hypertension may increase the chance of LVEF recovery.

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Section: Discussionmentioning

confidence: 99%

Evaluation of the pharmacotherapeutic impact on contractility recovery in patients with newly diagnosed, acute onset dilated cardiomyopathy

Orszulak,

Baasansuren,

Balwierz

et al. 2023

Medicine

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“…Multiple studies have shown that the administration of certain drugs (e.g., Sacubitril-Valsartan, Carvedilol, or Spironolactone) improves the E a /E es ratio, and thus, VAC in addition to their known clinical benefits [46][47][48][49].…”

Section: Chronic Heart Failure With Reduced Ejection Fractionmentioning

confidence: 99%

Development and Clinical Application of Left Ventricular–Arterial Coupling Non-Invasive Assessment Methods

Gamarra,

Díez-Villanueva,

Salamanca

et al. 2024

JCDD

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The constant and dynamic interaction between ventricular function and arterial afterload, known as ventricular-arterial coupling, is key to understanding cardiovascular pathophysiology. Ventricular–arterial coupling has traditionally been assessed invasively as the ratio of effective arterial elastance over end-systolic elastance (Ea/Ees), calculated from information derived from pressure–volume loops. Over the past few decades, numerous invasive and non-invasive simplified methods to estimate the elastance ratio have been developed and applied in clinical investigation and practice. The echocardiographic assessment of left ventricular Ea/Ees, as proposed by Chen and colleagues, is the most widely used method, but novel echocardiographic approaches for ventricular–arterial evaluation such as left ventricle outflow acceleration, pulse-wave velocity, and the global longitudinal strain or global work index have arisen since the former was first published. Moreover, multimodal imaging or artificial intelligence also seems to be useful in this matter. This review depicts the progressive development of these methods along with their academic and clinical application. The left ventricular–arterial coupling assessment may help both identify patients at risk and tailor specific pharmacological or interventional treatments.

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“…98,99 This is through the amelioration of the adverse effects of aldosterone that promotes LV hypertrophy and fibrosis. Spironolactone has demonstrated volumetric reverse remodelling in HFrEF when assessed by TTE [100][101][102] and CMRI. 103 In non-ischaemic cardiomyopathy, the mineralocorticoid receptor antagonist (MRA) dose may influence remodelling, with a high dose spironolactone therapy resulting in a greater improvement in LVEDV, LVEDD, and LVEF than low dose.…”

Section: Mineralocorticoid Receptor Antagonistmentioning

confidence: 99%

Cardiac reverse remodelling by imaging parameters with recent changes to guideline medical therapy in heart failure

Kodsi,

Makarious,

Gan

et al. 2023

ESC Heart Failure

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Recently established heart failure therapies, including sodium glucose co‐transporter 2 inhibitors, angiotensin‐neprilysin inhibitors, and cardiac resynchronization therapy, have led to both clinical and structural improvements. Reverse remodelling describes the structural and functional responses to therapy and has been shown to correlate with patients' clinical response, acting as a biomarker for treatment success. The introduction of these new therapeutic agents in addition to advances in non‐invasive cardiac imaging has led to an expansion in the evaluation and the validation of cardiac reverse remodelling. Methods including volumetric changes as well as strain and myocardial work have all been shown to be non‐invasive end‐points of reverse remodelling, correlating with clinical outcomes. Our review summarizes the current available evidence on reverse remodelling in heart failure by the non‐invasive cardiac imaging techniques, in particular transthoracic echocardiography.

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Modification of ventriculo–arterial coupling by spironolactone in nonischemic dilated cardiomyopathy

Cited by 5 publications

References 51 publications

Evaluation of the pharmacotherapeutic impact on contractility recovery in patients with newly diagnosed, acute onset dilated cardiomyopathy

Evaluation of the pharmacotherapeutic impact on contractility recovery in patients with newly diagnosed, acute onset dilated cardiomyopathy

Development and Clinical Application of Left Ventricular–Arterial Coupling Non-Invasive Assessment Methods

Cardiac reverse remodelling by imaging parameters with recent changes to guideline medical therapy in heart failure

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