In asymptomatic or mildly symptomatic patients with LV systolic dysfunction, the efficacy of aldosterone receptor antagonists is not fully established. Therapy with canrenone, a spironolactone metabolite that is not available for therapeutic use in the United States, however, modestly improves LV ejection fraction in NYHA class II CHF patients, leading to a reduction in cardiac death and hospitalization rates.20 Further data evaluating eplerenone in this patient subgroup are forthcoming from the Effect of Eplerenone in Chronic Systolic Heart Failure (EMPHASIS-HF) trial.