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After \u22656 months' treatment in NIDCM patients, LV volumes and mass decreased, and the LV ejection fraction increased from a median of 24% (17, 27) (interquartile range IQR) to 47 (42, 52) (P &amp;lt; 0.002), with a marked reduction in arterial elastance (Ea) from 2.89 mmHg\/mL (2.34, 4.0) to 1.50 (1.29, 1.95) (P &amp;lt; 0.002), similar to Ea of normal subjects, 1.53 (1.34, 1.67) (P &amp;gt; 0.05). The V\u2013A coupling ratio, Ea\/end-systolic elastance (single-beat method), decreased by \u22121.08 (\u22121.96, \u22120.55), (P = 0.003), as did Ea\/end-systolic pressure\/end-systolic pressure ratio, \u22120.54 (0.35, 0.87), (P = 0.002). The preload recruitable stroke work (PRSW) increased as did PRSW indexed for Ea (both P = 0.002), which reflected \u2018total circulatory performance\u2019.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In NIDCM, adding MRA to conventional anti-failure therapy markedly improved LV ejection fraction and reduced peripheral vascular resistance, due to both improved LV contractility and especially to enhanced V\u2013A coupling, as Ea decreased to normal. Total circulatory performance was a sensitive indicator of both LV pump performance and the arterial loading conditions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ehf2.13161","type":"journal-article","created":{"date-parts":[[2021,1,6]],"date-time":"2021-01-06T18:55:06Z","timestamp":1609959306000},"page":"1156-1166","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Modification of Ventriculo\u2013Arterial Coupling by Spironolactone in Nonischemic Dilated Cardiomyopathy"],"prefix":"10.1093","volume":"8","author":[{"given":"Mark A.","family":"Lawson","sequence":"first","affiliation":[{"name":"VA Tennessee Valley Health Care System, Vanderbilt University Medical Center , Nashville, TN, 37232 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David E.","family":"Hansen","sequence":"additional","affiliation":[{"name":"VA Tennessee Valley Health Care System, Vanderbilt University Medical Center , Nashville, TN, 37232 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deepak K.","family":"Gupta","sequence":"additional","affiliation":[{"name":"VA Tennessee Valley Health Care System, Vanderbilt University Medical Center , Nashville, TN, 37232 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan P.","family":"Bell","sequence":"additional","affiliation":[{"name":"VA Tennessee Valley Health Care System, Vanderbilt University Medical Center , Nashville, TN, 37232 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas W.","family":"Adkisson","sequence":"additional","affiliation":[{"name":"VA Tennessee Valley Health Care System, Vanderbilt University Medical Center , Nashville, TN, 37232 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ravinder R.","family":"Mallugari","sequence":"additional","affiliation":[{"name":"VA 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