Spironolactone Therapy in Chronic Stable Right HF Trial

Other illness

• Moderate or severe aortic or valvular disease.
• Severe Liver Failure (Child-Pugh Class C)

Lab values

• Patients on chronic MRA therapy or other potassium sparing diuretics.
• Baseline serum potassium\>5 ummol/l.
• LV ejection fraction \<45%,

Other

• Estimated glomerular filtration rate \<30 ml/min.
• Moderate or severe LV diastolic function,
• Patients requiring augmentation of diuretics or otherwise not meeting definition for clinical stability.
• 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.

• 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:
  • 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