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Cited by 104Cardiovascular Function and Risk FactorsCardiac Fibrosis and RemodelingCardiovascular Disease and Adiposity

Fibrosis and cardiac function in obesity: a randomised controlled trial of aldosterone blockade

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Kosmala, Wojciech, Przewlocka-Kosmala, Monika, Szczepanik-Osadnik, Hanna, Mysiak, Andrzej, Marwick, Thomas H·2013·Heart
DOI 10.1136/heartjnl-2012-303329
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Abstract

Objectives: As myocardial fibrosis might be an important contributor to the association of obesity with left ventricular (LV) dysfunction and heart failure, we investigated the effects of spironolactone on LV function and serological fibrosis markers (procollagen type III N-terminal propeptide (PIIINP) and procollagen type I C-terminal propeptide (PICP)) in patients with obesity and abnormal LV performance. Design: A prospective, randomised, double-blind, placebo-controlled study. Setting: A university hospital. Patients and intervention: 113 patients (mean±SD age 58±8 years) with body mass index≥30, without any comorbidities, with impaired early diastolic mitral annular velocity, randomised to spironolactone 25 mg/day or placebo for 6 months. Main outcome measures: Echocardiographically derived indices of LV systolic (strain and strain rate) and diastolic (E velocity, tissue e′ and E/e′ ratio) function, myocardial reflectivity (calibrated integrated backscatter (IB)), and serum PICP and PIIINP. Results: In the spironolactone group, significant improvements in myocardial deformation, peak early diastolic velocity (Em), E/e′ and IB were noted with a simultaneous decrease in PICP and PIIINP. No corresponding alterations were found with placebo. Improvement in LV systolic function (increase in strain) was independently associated with baseline strain (β=−0.43, p<0.001), change in IB (β=0.26, p<0.02) and baseline PICP (β=0.24, p<0.04). Among the independent determinants of LV diastolic improvement were for increase in Em – baseline Em (β=−0.44, p<0.001) and baseline PICP (β=0.35, p<0.002), and for decrease in E/e′ – baseline E/e′ (β=−0.35, p<0.005) and change in PICP (β=0.25, p<0.04). Conclusions: In patients with obesity without other comorbidities, aldosterone antagonism improves LV function and myocardial acoustic properties, and reduces circulating procollagen levels. Beneficial changes in cardiac performance are independently predicted by baseline LV dysfunction and baseline disturbances, as well as treatment-induced improvements in fibrosis markers. Clinical Trial Registration: http://www.anzctr.org.au ACTRN12609000655246.

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  • MR antagonism improved brachial artery flow-mediated dilation and left ventricular function in patients with obesity and left ventricular diastolic dysfunction.

    “In addition, MR antagonism improved brachial artery flow-mediated dilation (an index of vascular endothelial function)75 and left ventricular function in patients with obesity and left ventricular diastolic dysfunction76.”

    From Obesity, kidney dysfunction and hypertension: mechanistic links (2019) · cites this paper as [76]

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  1. Kosmala W, et al. Heart 2013;99:320-326. doi:10.1136/heartjnl-2012-303329 Obesity and the heart on July 16, 2023 by guest. Protected by copyright. http://heart.bmj.com/ Heart: first published as 10.1136/heartjnl-2012-303329 on 23 January 2013. Downloaded from REFERENCES
  2. Kosmala W, Przewlocka-Kosmala M, Szczepanik-Osadnik H, et al. Beneficial effect of aldosterone antagonism on left ventricular function and structure and fibrosis markers in the metabolic syndrome-a randomized trial. J Am Coll Cardiol Cardiovasc Imaging 2011;4:1239-49.

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Authors
Kosmala, W., Przewlocka-Kosmala, M., Szczepanik-Osadnik, H., Mysiak, A., & Marwick, T. H.
Affiliations
  • Wroclaw Medical University (PL)
  • Department of Cardiology, Wroclaw Medical University, Wroclaw, Poland
  • The University of Queensland (AU)
Corresponding author
Marwick, Thomas H
ORCID
Venue
Heart
Publisher
BMJ
Published
2013-01-23
Volume
99
Issue
5
Pages
320-326
ISSN
  • 1355-6037 (ISSN-L)
  • 1468-201X
DOI
10.1136/heartjnl-2012-303329
OpenAlex
W2102779499
Cited by
104
References
37
Citations by year
2026: 3 · 2025: 2 · 2024: 5 · 2023: 3 · 2022: 10 · 2021: 8 · 2020: 12 · 2019: 9 · 2018: 7 · 2017: 15 · 2016: 6 · 2015: 15 · 2014: 5 · 2013: 4
FWCI
6.79
Type
journal article
Language
en
Open access
Locations
  • Heart (publishedVersion)
  • PubMed (publishedVersion)
  • eCite Digital Repository (University of Tasmania) (submittedVersion)
  • Figshare (submittedVersion, cc-by)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Fibrosis and Remodeling
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Disease and Adiposity
Keywords
obesity, myocardial fibrosis, spironolactone, aldosterone antagonism, left ventricular function, diastolic dysfunction, myocardial strain, integrated backscatter, PIIINP, procollagen type I C-terminal propeptide, heart failure, cardiac remodeling, mitral annular velocity, echocardiography, biomarkers
MeSH terms
Mineralocorticoid Receptor Antagonists, Double-Blind Method, Female, Fibrosis, Follow-Up Studies, Heart Ventricles, Humans, Male, Middle Aged, Myocardium, Obesity, Prospective Studies, Spironolactone, Echocardiography, Doppler, Body Mass Index, Ventricular Function, Left, Treatment Outcome, Ventricular Dysfunction, Left

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