Spironolactone improves lung diffussion in chronic heart failure

Aims: To evaluate whether anti-aldosteronic treatment influences lung diffusion (DLco) in chronic heart failure (HF) patients. Spironolactone improves clinical conditions and prognosis in chronic HF and reduces connective tissue matrix turnover; DLco abnormalities in chronic HF are related to increase in fibrosis and connective tissue derangement. Methods and results: Thirty stable chronic HF patients, with reduced DLco (<80% of predicted), were randomly assigned to active treatment (25 mg spironolactone daily) or placebo in addition to conventional anti-failure treatment. They were evaluated by quality of life questionnaire, laboratory investigations, cardiopulmonary exercise test, and pulmonary function test, which included DLco and membrane diffusing capacity (DM). The evaluation was done before treatment and 6 months after. Quality of life score and standard pulmonary function tests were not significantly affected by spironolactone, while active treatment increased DLco due to an increase of DM (DLco: 18.3 (plus or minus) 3.9 vs. 19.9 (plus or minus) 5.5 mL/min/mmHg; DM: 28.1 (plus or minus) 7.7 vs. 33.3 (plus or minus) 8.6 mL/min/mmHg) and peak oxygen consumption (peak VO2 16.8 (plus or minus) 1.9 vs. 18.6 (plus or minus) 2.2 mL/min/kg). Increments of DLco and peak VO2 were linearly related (R = 0.849, P < 0.001). Conclusion: These data show a positive effect of spironolactone on gas diffusion and exercise capacity suggesting a novel mechanism by which anti-aldosteronic drugs improve HF clinical condition and prognosis.