The Effects Of Anti-aldosterone Treatment On Change Of Neurohormone And Cardiac Function To Patients With Myocardial Infarction

AIM: To observe the effect of anti -aldosterone treatment on the changes of plasma concentrations of neurohomone and left ventricular function in patients with myocardial infarction those have received treatment of ACEI, and to evaluate efficacy and safety of anti -aldosterone treatment.METHOD: From Jan 2002 to Jan 2004, 230 patients with myocardial infarction were enrolled and randomly assigned to anti -aldosterone treatment group (spironolactone 20-40mg per day plus fosinopril 5-10mg per day, n=130) or conventional treatment group (enalapril 10-20mg per day, n=130). The ultrasoundcardiogram and laboratory investigations were performed at enrolling time, and after 3, 6, 12 months. The plasma concentrations of neurohomone were examined at enrolling time and after 6 months.RESULTS: Ninety patients completed 12 months of follow-up. In the anti -aldosterone treatment group ( n=49 ), plasma concentrations of aldosterone (Ald ) increased at 6 months ( z= -2.70, p< 0.01 ), periplasmal renin activity (PRA) and plasma concentrations of angiotensin II (Ang II) did not change between baseline and 6 months (z=0.28, p= 0.78 and z= 0.20, p= 0.84, respectively) .In the conventional treatment group ( n=41 ), PRA, Angâ…¡ and NE fell at 6 months ( z= 2.41, p<0.05; z=3.63, p<0.01; z=1.98, p<0.05, respectively). After 12 month follow-up, the left ventricular ejection function (LVEF) was significantly improved in the anti -aldosterone treatment group, and significantly improved in the conventional treatment group. The improvement ratio of LVEF was different between two groups at 12 months (t=2.36, p=0.02) .