Abstract 17126: Spironolactone Improves Left Ventricular Longitudinal Strain And E/e’ In Patients With Atrial Fibrillation And Preserved Ejection Fraction: Results From A Randomized, Double-blind, Placebo-controlled Trial (INSPIRE-AF)

BackgroundSpironolactone has antifibrotic properties and may reduce adverse structural remodeling in atrial fibrillation (AF). PurposeTo evaluate the efficacy of spironolactone in improving left ventricular (LV) function as assessed by 2-dimensional transthoracic echocardiography (TTE) including speckle tracking, in patients with paroxysmal and persistent AF.MethodsINSPIRE-AF is an investigator-initiated, randomized, double-blind, placebo-controlled trial (NCT02764619). Study participants with paroxysmal (n=58) and persistent (n=67) non-valvular AF and LV ejection fraction (EF) ≥40% were randomized to either spironolactone 25 mg (SPL group) or placebo (PL group) once daily in addition to standard medical treatment. Resting TTE examinations were conducted at inclusion and at 12 months. Volumes, transmitral flow, tissue Doppler, strain, and strain rate were assessed using commercially available software. AF recurrences were documented using 12-lead electrocardiograms.ResultsA total of 125 subjects (mean age 64 years, 64% male, LVEF 55±6%) were randomized to the SPL-group (n=63) and the PL-group (n=62), respectively. Baseline clinical and echocardiographic characteristics were well-balanced between the two treatment groups. E/é decreased significantly in the SPL-group (mean change from baseline in the SPL-group = -0.15±2.09 vs. PL-group = 0.75±1.95, p=0.03). No significant between-group changes in left atrial and LV volumes or LV strain and strain rates were found. However, in the group of patients with persistent AF, LV peak global longitudinal strain (mean increase in the SPL-group =2.70±3.63 vs. PL-group = 0.36±3.47, p=0.008), peak systolic longitudinal strain (mean increase in the SPL-group = 2.73±3.71 vs. PL-group = 0.46± 3.61, P=0.01), and peak systolic longitudinal strain rate (mean increase in the SPL-group = 0.12±0.25 vs. PL-group = 0.01±0.26, P=0.08) were all significantly improved in the SPL-group (P=0,02 for all interactions).ConclusionIn patients with AF and preserved LVEF, spironolactone reduced E/é, a potential sign of improved LV diastolic function. Longitudinal global and systolic strain and strain rate were only improved in patients with persistent AF.