Effect of Early Spironolactone on the ST2 Level and Clinical Changes in Acute Decompensated Heart Failure Patients

Trisulo Wasyanto, Atik Mufidah


Background: In spite ofmajor advances in therapy, morbidity, and mortality due to acute decom­pen­sated heart failure (ADHF) remain poor. Early initiation of mineralocorticoid antagonist (spironolactone) may increase the suppression of negative effect of renin-angiotensin-aldosterone system (RAAS) activation, even though it already uses ACEI/ARB accompanying ADHF and give a better outcome. This study aims to determine the effect of early spironolactone 100 mg a day for 3 consecutive days on the suppression of tumorigenicity 2 (ST2) level and clinical changes in patients with ADHF.

Subjects and Method: This was a randomized single blind controlled trial. Thirty eight conse­cutive patients with ADHF hospitalized at Dr. Moewardi Hospital, Surakarta were randomized into two groups: spironolactone group (standard therapy plus spironolactone 100 mg per day for 3 day, n=19) and control group (standard therapy, n=19). Clinical sign and simptom of ADHF was monitored everyday and the difference of clinical changes was evaluated at the day-3. Venous blood samples were collected from all patients at the first day prior therapy and day-4 after therapy. The dependent variable was ST2 level. The independent variable wasSpironolacton therapy. The data were analyzed by independent t-test.

Results: Decreased levels of ST2 in the spironolactone group (mean= 36.96; SD= 21.29) was higher than the control group (mean= 19.73; SD= 16.48) and it was statistically significant (p= 0.008). Spironolacton therapy 100 mg once daily at the first 3 day in patient with ADHF was safe, no hiperkalemia, or worsening renal function. There was decreasing risk of hipokalemia up to 33% (RR= 0.33; 95% CI= 0.1 to 1.0; p= 0.036) and greater proportion patient with improvement clinical simptom and sign of ADHF at day-3 in the spironolactone group vs control group.

Conclusion: Administration of spironolactone 100 mg at the first 3 day plus standard therapy decreases levels of ST2, safe, decreases risk of hipokalemia and give greater proportion of clinical improvement patients ADHF.

Keywords: Spironolactone, ADHF, ST2

Correspondence: Trisulo Wasyanto. Department of Cardiology and Vascular Medicine, Faculty of Medicine, Uni­versitas Sebelas Maret/Dr. Moewardi Hospital. Jl. Kol. Sutarto 132, Surakarta 57126. Indonesia. Email: 

Indonesian Journal of Medicine (2019), 4(3): 232-240

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