NEW YORK (Reuters Health) – Patients with NYHA class I or II heart failure benefit from spironolactone therapy as well as those with class III or IV HF, an Italian team reports.

Dr. Enrico Vizzardi, at the University of Brescia, and colleagues point out in the American Journal of Cardiology online September 9 that the reduction in mortality and hospitalizations with long-term spironolactone treatment of heart failure has been demonstrated mainly in patients in New York Heart Association (NYHA) functional class III to IV.

Their team’s current study was aimed at assessing the effect of 6 months of spironolactone in addition to standard therapy in patients with low-to-moderate grade HF (NYHA class I to II). They randomized 168 such patients to spironolactone or placebo. “The initial dosage of spironolactone drugs was 25 mg/day with uptitration every 2 weeks to 50 or 100 mg/day if tolerated.”

After 6 months, in the spironolactone groups compared with the placebo groups, left ventricular ejection fractions increased (3.9 vs 1.2 percentage points),LV end diastolic volume (26.8 vs 7.0 mL), and LV mass decreased (26 g vs 3 g), according to the report. All between-group differences were significant.

Despite the favorable effects, however, Dr. Vizzardi and colleagues note that the number of patients was too small to draw conclusions about outcomes. As they point out, “Because of the relatively low rate of events in patients with NYHA class I to II HF, such a study would require enrollment of thousands of patients.”

Reference:
Effect of Spironolactone on Left Ventricular Ejection Fraction and Volumes in Patients With Class I or II Heart Failure
Am J Cardiol 2010.