Aldosterone antagonism in an inflammatory state: evidence for myocardial protection.

ABSTRACT

INTRODUCTION: Chagas' disease is one of the most important causes of dilated cardiomyopathy in South and Central America. It is an inflammatory cardiomyopathy. We wanted to investigate whether it could have the same response to aldosterone antagonism as demonstrated before in other dilated cardiomyopathies. OBJECTIVE: To evaluate the role of spironolactone in myocardial remodelling in a Chagas cardiomyopathy model. MATERIAL AND METHODS: We studied 60 Sirius Hamsters divided into control (C) infected (Inf) and Inf plus spironolactone (Infsp, 40 mg/kg/day) groups, for 11 months. Echocardiography with colour doppler was performed. Left ventricular end diastolic diameter (LVEDD), fractional shortening (FS) and corrected isovolumic relaxation time (IRT) were evaluated, as well as interstitial collagen volume fraction (ICVF) and myocardial inflammation. RESULT: The results demonstrated that survival was improved by use of spironolactone in the chronic phase (p<0.04). Body weight (BW) was C190 g, Inf167 g*, Infsp198 g (*p<0.05, compared to C and Infsp), LVEDD/BW was C0.31, Inf 0.35*, Infsp 0.29 (*p<0.05, compared to C and Infsp), FS was C38, Inf 35.5, Infsp 38 (with no statistical difference) and IRT was C 23 msec, Inf 26 msec*, Infsp 22 msec (p<0.05, compared to C and Infsp). ICVF (%) was attenuated at LV (C 0.34+/-0.1, Inf 1.75+/-0.7*, Infsp 0.95+/-0.2*; *p<0.05, p<0.05). CONCLUSION: Spironolactone attenuated the myocardial remodelling in Chagas cardiomyopathy, reduced mortality during the chronic phase and reduced inflammatory infiltration.