Myocardial structural effects of aldosterone receptor antagonism in heart failure.

he remarkable effectiveness of aldosterone receptor antagnists in reducing the mortality risk in patients with dvanced heart failure (HF) (1) has led many to assume that he aldosterone receptor is directly involved in the process of eft ventricular (LV) remodeling, which seems to be a ritical mediator of the progressive syndrome of HF (2,3). his perception has been fed by preclinical evidence for ldosterone-mediated myocardial fibrosis and remodeling 4,5). But persuasive evidence has been lacking from an dequately controlled clinical trial to demonstrate that the avorable effect of this therapy could be attributed to its nti-remodeling effect rather than to another mechanism, uch as an antiarrhythmic response to potassium retention. urthermore, the interaction between aldosterone receptor lockade and the other neurohormonal inhibitors used in F has not been explored.