March 4th, 2013
Selections from Richard Lehman’s Literature Review: March 4th
Richard Lehman, BM, BCh, MRCGP
CardioExchange is pleased to reprint selections from Dr. Richard Lehman’s weekly journal review blog at BMJ.com. Selected summaries are relevant to our audience, but we encourage members to engage with the entire blog.
JAMA 27 Feb 2013 Vol 781
Effect of Spironolactone on Diastolic Function and Exercise Capacity in Patients with HF with Preserved EF (pg. 781): Heart failure divides into two broad classes: the first is caused by damage to the myocardium and is associated with reduction in the left ventricular ejection fraction, and we know pretty well how to treat it; the second is associated with stiffening of the ventricles and the main capacitance vessels, and we don’t know how to treat it, or even what to call it. It is often called “diastolic HF” but this term should really be reserved for the subset who have demonstrable reduction in diastolic filling. And as we fuss over these imaging-based definitions we lose sight of the patient as a whole, who is typically elderly and hypertensive with other comorbidities and taking a variety of pre-existing medication. That’s not to say we shouldn’t try to apply some science to improving their treatment, and this German-Austrian trial was inspired by the theoretical possibility that aldosterone blockade would reverse some of the effects of diastolic dysfunction. And it did. But unfortunately the patients could not notice any difference between spironolactone 25mg and placebo, because what little benefit the former had was purely on LV remodelling and BNP levels. Their diastolic filling indices actually dropped and so (non-significantly) did their walking distance.
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