Spironolactone Therapy in Chronic Stable Right HF Trial (STAR-HF)

This is an interventional treatment trial for Chronic Right-Sided Heart Failure focused on measuring Mineralocorticoid receptor antagonist, Brain natriuretic peptide (BNP), Sympathetic Nervous System, Positron Emissions Tomography Read More

Inclusion Criteria:

• Provide a personally signed and dated inform consent form.
• Male or female ≥ 18 years.
• Able to comply with all study procedures.

• History of right heart failure (RHF) secondary to either:

  i) WHO, group 1 pulmonary arterial hypertension PAH OR ii) WHO group II PH with normal LV systolic function OR iii) WHO group III or IV PH OR iv) primary RV cardiomyopathy.

• Current NYHA II-IV

• RV dysfunction as measured by 2D echocardiogram:

  i)defined as a tricuspid annular plane systolic excursion (TAPSE) <16 mm ii) and /or a two dimensional fractional area change <35% on screening echo plus

• NT-proBNP>400 pg/ml
• Chronic use of diuretics
• Clinical stability: defined as no need for increased diuretics, hospitalization or emergency room visit 3 months prior to enrollment

Exclusion Criteria:

• Patients on chronic MRA therapy or other potassium sparing diuretics.
• Baseline serum potassium>5 ummol/l.
• Estimated glomerular filtration rate <30 ml/min.
• LV ejection fraction <45%,
• Moderate or severe LV diastolic function,
• Moderate or severe aortic or valvular disease.
• Patients requiring augmentation of diuretics or otherwise not meeting definition for clinical stability.
• Severe Liver Failure (Child-Pugh Class C)
• Claustrophobia or inability lie still in a supine position
• Patients with contraindications to either PET or CMR imaging
• Pregnancy or lactation.
• Unable to provide consent and comply with follow up visits.