Sixty-five asymptomatic patients with a peak aortic valve velocity >3.0 m/s and normal LV function were randomized double blind to eplerenone, 100 mg daily (n = 33), or placebo (n = 32) for a median of 19 (interquartile range 15 to 25) months. Cardiac magnetic resonance imaging and echocardiography were performed and N-terminal pro-brain natriuretic peptide was measured at baseline and follow-up.
Symptomatic deterioration occurred in 13 subjects randomized to eplerenone and 11 to placebo (P = .34). Change in LV mass index (mean change ± SD −0.3 ± 14.6 vs +5.1 ± 15 g/m2 per year, P = .3), LV ejection fraction (+0.0 % ± 5.7 % vs +0.8 % ± 5.7 % per year, P = .9), and LV end-systolic volume index (−1.2 ± 9 vs +0.04 ± 12 mL/m2 per year, P = .8) were small and similar for patients randomized to eplerenone and placebo, respectively. Decrease of aortic valve area (−0.11 ± 0.22 vs −0.18 ± 0.24 cm2/y, P = .2), worsening of LV diastolic dysfunction by echo-Doppler (E/E' +0.49 ± 0.7 vs +1.32 ± 2.0/year, P = .4), increase in the plasma level of N-terminal pro-brain natriuretic peptide (+63 % vs +12 % per year, P = .1), and decline in physical function score (9 ± 34 vs 12 ± 37/year, P = .7) were similar for subjects randomized to eplerenone and placebo, respectively.
In asymptomatic patients with moderate-severe aortic stenosis, eplerenone did not slow onset of LV systolic or diastolic dysfunction, decrease LV mass, or reduce progression of valve stenosis.