Abstract: AIM: To investigate the effects of spironolactone on cardiac function and serum brain natriuretic peptide (BNP) level in patients with chronic heart failure (CHF).METHODS: 42 patients with CHF, defined as New York Heart Association (NYHA) functional classes Ⅱ-Ⅳ, received medication of diuretic, digitalis and angiotensin-converting enzyme inhibitor.The patients were randomly divided into the treatment group (extra spironolactone 20 mg daily, n =21) and the control group (n =21).The changes of NYHA functional class were evaluated before and after the treatment for 1 mon.The levels of BNP-32 in serum were measured by immunoradiometric assay immediately after administration.Left ventricular ejection fraction (LVEF) and left ventricular internal dimension at end-diastole (LVED) were measured by M-mode Echocardiography.BNP, LVEF and LVED were re-checked 3 mon later.RESULTS: The total effective rates were 85.7 % in the spironolactone group and 76.2 % in the control group (P <0.05), and the evident effective rates were 61.9 % in the spironolactone group and 42.9 %in the control group (P <0.05).Spironolactone significantly decreased NYHA functional class (P <0.05) after 1 mon therapy in patients of the treatment group, which had no difference from the control group.Spironolactone significantly increased LVEF (P < 0.05), and decreased LVED (P <0.05) after 3 mon therapy in patients of the treatment group, but had no difference in those of the control group.There were significantly attenuated BNP levels in patients with CHF between two groups (P <0.05), but were more decreased in the spironolactone group (P <0.01).Changes in BNP levels were significant negative correlation with CHF patients in the spironolactone group after medication in LVEF (r =-0.42, P <0.05), and significant positive correlation with those in LVED (r =0.60, P <0.05). CONCLUSION: Spironolactone can not only improve left ventricular remodeling and cardiac function but also lower BNP levels in CHF patients.Serum BNP level may serve as a therapeutic indicator for spironolactone treatmemt in CHF patients.

Key words: spironolactone, heart failure, left ventricular ejection fraction, brain natriuretic peptide, evaluating curative effect