Early Administration of Mineralocorticoid Receptor Antagonist Is Useful for Cardiac Reverse Remodeling in Asymptomatic Patients with Dilated Cardiomyopathy

Background: Cardiac reverse remodeling (CRR) is considered to be one of surrogate markers of favorable prognosis in dilated cardiomyopathy (DCM). The administration of mineralocorticoid receptor antagonist (MRA) with ACE inhibitor and beta blocker is recommended to reduce future cardiac events in all symptomatic heart failure patients with reduced ejection fraction. However, little is known about the efficacy of MRA for asymptomatic heart failure patients. We aimed to investigate the association between early administration of MRA and CRR in asymptomatic DCM patients. Methods: We enrolled 74 DCM patients classified as NYHA I in this retrospective cohort study. All patients were divided into two groups; MRA(+) group (n = 33) and MRA(-) group (n = 41). CRR was defined as an absolute increase in left ventricular ejection fraction ≧10% accompanied by a decrease in left ventricular end-diastolic diameter >10% as assessed by echocardiography at 12 months. Results: As for baseline characteristics, the mean of left ventricular ejection fraction and end-diastolic diameter was 36% and 61 mm, respectively. The administration rate of ACE inhibitors/ARBs and was 82% and 81%. Thirty-three (45%) patients were treated with MRA. The rate of CRR was significantly higher in MRA(+) group than in MRA(-) group (58% vs 27%, P = .007). Conclusions: Early administration of MRA is useful for CRR in asymptomatic NYHA I patients with DCM, which may potentially result in a good prognosis.