Larger Dose of Spironolactone for the Treatment of Patients With Nonischemic Cardiomyopathy
Larger Dose of Spironolactone for the Treatment of Patients With Nonischemic Cardiomyopathy
The purpose of this study is to determine whether a larger dose of the aldosterone antagonist
 spironolactone combined with a lower dose of an ACE inhibitor is more effective in reverse
 left ventricular remodeling in severe congestive heart failure in patients with nonischemic
 cardiomyopathy.
In the investigators' recent daily clinical practice, they found that the larger dose of the
 aldosterone antagonist spironolactone combined with a lower dose of an ACE inhibitor and the
 highest tolerable dose of beta blockers could reverse left ventricular remodeling more
 effectively than a smaller dose of spironolactone. The ventricular remodeling could get back
 to normal, especially in patients with none-ischaemic cardiomyopathy. The investigators
 hypothesize that long term use of a larger dose of the aldosterone antagonist spironolactone
 could reverse left ventricular remodeling by stimulating new myocyte formation. Thus, they
 designed this study to verify its efficacy and safety in reversing left ventricular
 remodeling in severe congestive heart failure in patients with nonischemic cardiomyopathy. To
 avoid hyperkalemia, the investigators routinely use larger doses of diuretics in combination
 with a lower dose of an ACE inhibitor to offset the potassium-sparing effects of
 spironolactone and follow the patients closely.
Inclusion Criteria:

 -  New York Heart Association (NYHA) Functional class Ⅲ or Ⅳ

 -  Left Ventricular Ejection Fraction (LVEF) <35%

 -  Nonischemic cardiomyopathy

 -  Preserved renal function: Cr ≤2.5 mg/dL in males; Cr ≤2.0mg/dL in females

 Exclusion Criteria:

 -  Hyperkalemia (≥5.0 mEg/L)

 -  Left ventricular systolic dysfunction with pericardial diseases, congenital heart
 diseases, pulmonary heart diseases, heart valvular diseases, acute coronary syndrome
 and short life expectancy.