Efficay and safety of different doses of spironolactone in treating elderly patients with heart failure of reduced ejection fraction

Ou Li-juan; Guan Wen-jie; Hou Yong; Ren Ying-ling; Song Rui-rui; Hong Zhan-mei

doi:10.3969/j.issn.1672-8157.2025.01.030

Abstract：Objective To investigate the efficacy and safety of different doses of spironolactone in the treatment of elderly pa-tients with heart failure of reduced ejection fraction(HFrEF).Methods A total of 79 elderly patients with HFrEF admitted to the Ninety-first Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army from June 2021 to June 2023 were selected as the research subjects.According to the simplified random grouping method(single-double number method),these 79 pa-tients were divided into the low-dose group(single number,n=40)and high-dose group(double number,n=39).The patients in both groups were given routine treatments such as sacubitril valsartan sodium tablets,metoprolol tartrate and other main drugs.Meanwhile,the patients in the low-dose group were treated with 20 mg spironolactone per day while those in the high-dose group were given 40 mg spironolactone per day.The clinical efficacy,cardiac function,6-minute walk test(6 MWT)distance,NYHA cardiac function grading,and myocardial injury markers(N-terminal pro-brain natriuretic peptide(NT-proBNP),serum lipoprotein-associated phos-pholipase A2(Lp-PLA2),cardiac troponin I(cTnI))before and after treatment and adverse reactions were compared between the two groups.After 1 year of follow-up,the differences in incidence of major adverse cardiovascular events(MACE)and cardiac function were recorded in both groups.Results The total effective rate of treatment was 87.18%(34/39)and 75.00%(30/40),respectively,in the high-dose group and low-dose group(χ2=1.904,P=0.168).After treatment,the left ventricular ejection fraction(LVEF),left ven-tricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD)and 6 MWT in the low-dose group and high-dose group((41.96±5.69)%,(55.21±3.14)mm,(49.46±4.87)mm and(396.88±23.35)m;(45.12±6.46)%,(53.56±2.88)mm,(47.02±3.36)mm,(433.32±25.11)m)were better than those before treatment((31.23±3.68)%,(58.66±3.56)mm,(53.11±5.35)mm and(328.69±18.22)m;(31.14±3.76)%,(57.74±3.51)mm,(53.24±5.38)mm and(331.63±19.31)m),and the above indicators in the high-dose group were better than those in the low-dose group(P<0.05).The NYHA cardiac function grading in low-dose group(Z=2.778,P=0.00)and high-dose group(Z=3.808,P<0.001)was improved as compared with that before treatment(Z=0.120,P=0.904),but there was no statistical difference in NYHA cardiac function grading between the high-dose group and low-dose group(Z=0.847,P=0.397).The NT-proBNP,Lp-PLA2 and cTnI levels in the low-dose and high-dose groups((2 185.98±125.52)pg·mL-1,(2.19±0.58)pg·mL-1 and(139.33±15.11)ng·mL-1;(1 903.32±118.41)pg·mL-1,(1.89±0.54)pg·mL-1 and(132.06±13.95)ng·mL-1)were better than those before treatment((4 124.32±145.56)pg·mL-1,(2.58±0.96)pg·mL-1 and(181.35±30.28)ng·mL-1;(4 118.56±137.42)pg·mL-1,(2.59±0.92)pg·mL-1 and(182.56±31.57)ng·mL-1),and they were lower in the high-dose group than in the low-dose group(P<0.05).The incidence of adverse reactions was 10.24%(4/39)in the high-dose group and 7.50%(3/40)in the low-dose group(χ2=0.185,P=0.666).After 1 year of follow-up,there was no statistically significant difference in MACE rate between the low-dose group and high-dose group(25.00%(10/40)vs 15.38%(6/39))(χ2=1.130,P=0.288).The LVEF,LVEDD,LVESD and 6 MWT after 1 year of follow-up were(41.32±4.69)%,(55.63±3.77)mm,(49.75±4.96)mm and(385.88±20.35)m in the low-dose group and(44.88±5.46)%,(53.75±3.24)mm,(47.16±4.17)mm and(428.88±24.35)m in the high-dose group,and the indicators were better in the high-dose group than those in the low-dose group(P<0.05).Conclusion Both 20 mg·d-1 and 40 mg·d-1 spironolactone have good efficacy in the treatment of elderly patients with HFrEF.The 40 mg·d-1 dose has more advantages in improving ventricular re-modeling and relieving myocardial injury,and it does not significantly increase side effects and is safe and effective.