Abstract
Background
Myocardial fibrosis has proved to be an important marker and determinant in the pathogenesis
of hypertrophic cardiomyopathy. In particular, scar formation, if substantial, can
promote ventricular tachyarrhythmias or progressive heart failure in the absence of
left ventricular outflow obstruction. Therefore, an intervention to mitigate myocardial
fibrosis would be potentially advantageous to hypertrophic cardiomyopathy patients.
Methods
Eligible hypertrophic cardiomyopathy patients were randomized 1:1 in a prospective
double-blind fashion to spironolactone 50 mg or placebo to be taken over a 12-month
period. The primary endpoint was the effect of mineralocorticoid receptor blockade
on serum markers of collagen synthesis and degradation. A number of other functional
and morphologic variables and biomarkers comprised secondary exploratory measures.
Results
Fifty-three hypertrophic cardiomyopathypatients (41 ± 13 years old; 72% men) were
randomized; demographic and clinical variable were well matched at baseline. Absolute
change between baseline and 12 months did not differ between hypertrophic cardiomyopathy
patients treated with spironolactone and those receiving placebo with respect to serum
markers of collagen synthesis or degradation, fibrosis by late gadolinium enhancement
on cardiac magnetic resonance imaging, or other clinical variables, including objective
measure of functional capacity (peak VO2), New York Heart Association functional class, left ventricular wall thickness, mass
and volume, and left atrial size, as well as assessment of diastolic function (P = .4-1.0).
Conclusions
These findings do not support the use of spironolactone in hypertrophic cardiomyopathy
to improve left ventricular remodeling by mitigating myocardial fibrosis or altering
clinical course.
Keywords
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Article info
Publication history
Published online: March 28, 2018
Footnotes
Funding: This study was registered as a clinical trial with the National Institutes of Health (NIH) (NCT#0087-9060) and was supported by an NIH K-training grant (K23-HL086745-01) to MSM.
Conflict of Interest: None.
Authorship: All authors takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
