Effect of spironolactone therapy on echocardiographic parameters in patients with impaired left ventricular filling: A randomized controlled trial

Thirty-fifty percent of patients with heart failure presenting to emergency room have normal systolic function. This disorder is often seen in hypertensive old women. A common etiology of the disorder is diastolic dysfunction.The aim of this study was to demonstrate improvement of echocardiographic measurements with spironolactone treatment in diastolic dysfunction. Sixty-four patients who had diastolic dysfunction with preserved systolic function but not having any history of ischemic heart disease or past myocardial infarction were admitted. 33 patients were randomized to spironolactone, 31 patients to control group. A comprehensive echocardiographic examination was performed in these patients. Results of spironolactone and control groups have been compared at the end of six months treatment. No adverse effects or complications occurred during treatment of the study patients with spironolactone.In our study, there was a statistically significant decrease in E/A ratio, E, E/Mitral annular septal E, and E/Mitral annular lateral E ratio after treatment with spironolactone (p<0.05). There is a limited number of study that drug effects are compared to the diastolic functions. Most of patients had grade 1 diastolic dysfunction in these studies. Therefore, researchers of these studies have determined increased E/A ratio and E wave velocity opposite to the results of our study.Our results are compatible with regression of diastolic dysfunction from grade 2 to grade 1. In conclusion, spironolactone is an effective and reliable drug for the treatment of diastolic dysfunction. Future studies that will include more patients will provide more definitive results about this matter.