Research Of Spironolactone In Larger Dosage On The Ventricular Remodeling And Safety In Severe Congestive Heart Failure Patients

Objective: Chronic heart failure is a cluster of complicated clinical symptomatic syndrome. It is the severe end stage of all kinds of heart diseases. The morbidity rate is high and survival rate is similar to carcinoma in 5 years. In the Randomized Aldosterone Evaluation Study(RALES), spironolactone in smaller dosage (26mg/d) was shown to reduce the mortality and improve cardiac function of severe CHF patients who had already received routine therapy. After RALES study, more and more evidence have been established to support using spironolactone in heart failure. Do the patients of heart failure get more benefit for spironolactone in larger dosage? The pilot study of RALES shows, larger dose of spironolactone could provide more benefit in patients with CHF. However, its benefits were outweighed by higher occurrence of hyperkalemia, which predisposes patients to sudden death. In our daily clinical practice, we found hyperkalemia, the most fearful adverse event of spironolactone, could be counterbalanced by adding other diuretics. Therefore, we designed this study to determine the effects of larger dose of spironolactone in cardiac function, ventricular remodeling, cardiac systole function, electrolytes,...