The Clinical Observation Of Therapy Plus Spironolactone Treatment Of Chronic Heart Failure

Objective:The incidence and prevalence of chronic heart failure (CHF) are increasing every year, it has become a public health problem which can not be ignored. With the mechanism of occurrence and development of heart failure clarifying and the treatment progress, indicating the renin-angiotensin-aldosterone system(RAAS) and excessive activation of the sympathetic nervous system play important role in the development and progression of heart failure, the treatment of heart failure changes from traditional hemodynamic improvement to neurohormonal antagonist use to against abnormal activation of nerve and endocrine. As the publish of RALES findings, aldosterone receptor antagonist spironolactone becomes the third drug can improve the prognosis and reduce the mortality of heart failure,following the angiotensin-converting enzyme inhibitors (ACEI) and P-blockers.This study is a retrospective observation of 100 chronic systolic heart failure patients admitted to hospital recently,comparing the clinical efficacy between conventional therapy (ACEI/ARB, β-blockers, furosemide, hydrochlorothiazide, digoxin) and the addition of spironolactone treatment on the basis of conventional therapy,statistical analysis in the left atrial size, left ventricular ejection fraction, ECG, serum potassium, serum creatinine, etc.To observe impact of spironolactone on myocardial remodeling, cardiac arrhythmias and provide the basis for the security of additional spironolactone.Methods:Choose 100 patients with chronic systolic heart failure (NYHA Ⅱ-Ⅳ class, LVEF <40%) who were hospitalized in our hospital cardiology in 2011-2014,the addition of spironolactone treatment (experimental group) and not plus spironolactone treatment (control group) are separately 50 cases.They were diagnosed with chronic systolic heart failure based on patient history, symptoms, signs and cardiac ultrasound inspection,consistent with chronic systolic heart failure diagnostic criteria, and the heart failure duration≥6 months. Record the patients’ general situation including gender, age, etiology, disease duration, NYHA cardiac functional class,drugs and treatment courses. Compare patients of two groups before and after treatment of serum potassium, creatinine levels, ECG and cardiac ultrasound measurements of LVEF, left atrial size, left ventricular end-diastolic size, interventricular septum thickness, left ventricular posterior wall thickness.SPSS20.0 statistical software package for statistical analysis, count data between groups are compared using χ2 test, measurement data with the mean±standard deviation,are compared using independent samples t-test,P<0.05 is considered statistically significant. The indicators difference between the two groups before and after treatment is analyzed by covariance.Results:1. Between the two groups before treatment, baseline age, gender, etiology, disease duration, NYHA cardiac functional class, LVEF, left atrial size, left ventricular end-diastolic size, interventricular septum thickness, left ventricular posterior wall thickness, serum potassium, serum creatinine have no statistical difference (P>0.05) (Table 1).2. Baseline medication:the percentage of applications between the two groups, ACEI/ARB is undifferentiated, β-blockers has no statistical difference (P>0.05) (Table 2). The application percentage and the average dose between the two groups of furosemide/hydrochlorothiazide/digoxin have no statistical difference (P> 0.05) (Table 3 and 4), the course of treatment between the two groups shows no statistical difference (P> 0.05) (Table 1).3.The average dose of spironolactone in the experimental group is 31.6±12.2mg/d, the control group does not use spironolactone(Table 4).4. Serum potassium after treatment in the control group slightly increase, shows no statistical difference compared with pre-treatment(P=0.327), in the experimental group elevate after treatment, shows statistical differences(P=0.022),but serum potassium are within normal range, not appear hyperkalemia. Serum creatinine after treatment in the control group slightly increase, shows no statistical difference compared with pre-treatment(P=0.164),in the experimental group decrease after treatment,shows no statistical difference(P=0.177), two groups do not occur with severe renal impairment (Table 5,6).5. LVEF increase after treatment both in the control group and the experimental group and show statistical difference(the control group P=0.006, the experimental group P=0.002) (Table 5,6), no statistical difference between two groups (P=0.876) (Table 7). Left atrial size after treatment in the control group increase,shows statistical difference compared with pre-treatment(P=0.012), in the experimental group decrease slightly compared with pre-treatment, shows no statistical difference(P=0.209) (Table 5,6), there is statistical difference compared between the two groups (P=0.027) (Table 8). Left ventricular end-diastolic size, interventricular septum thickness, left ventricular posterior wall thickness after treatment in two groups show no statistical difference compared with pre-treatmen(P>0.05) (Table 5,6).6. Patients in the control group three cases in 11 cases of arrhythmia improved after treatment,patients in the experimental group seventeen cases in 20 cases of arrhythmia improved after treatment,there is statistically difference between two groups (P<0.05) (Table 9).Conclusion:For patients with chronic systolic heart failure (NYHA cardiac function Ⅱ-Ⅳ class), on the basis of conventional treatment add small dose of spironolactone treatment, which can effectively improve cardiac remodeling, reduce the incidence of arrhythmias while hyperkalemia and renal impairment do not increase. This combination therapy consistent with the current view of the biological treatment, improve heart failure symptoms and quality of life.