Spironolactone therapy for 12 to 18 months did not alter cardiac structure or function compared with placebo in HFpEF, though reduced left atrial volume predicted lower risk of the primary outcome.
RCT (n=239)
Does spironolactone improve cardiac structure and function, and do these changes predict outcomes in patients with heart failure with preserved ejection fraction?
In patients with HFpEF, 12 to 18 months of spironolactone therapy does not significantly alter cardiac structure or function, but reductions in left atrial volume are associated with improved clinical outcomes.
BACKGROUND: Limited data exist regarding the impact of aldosterone antagonist therapy on cardiac structure and function in heart failure with preserved ejection fraction and on the prognostic relevance of changes in cardiac structure and function in heart failure with preserved ejection fraction. METHODS AND RESULTS: Cardiac structure and function were assessed by quantitative echocardiography at baseline and at 12- to 18-month follow-up in 239 patients with heart failure with preserved ejection fraction (left ventricular LV ejection fraction LVEF ≥45%) enrolled in the Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist (TOPCAT) trial. The impact of spironolactone therapy on measures of cardiac structure and function was assessed in the study population overall, and change in echocardiographic measures was associated with the subsequent occurrence of the primary composite outcome of cardiovascular death, heart failure hospitalization, or aborted cardiac arrest. Spironolactone was not associated with alterations in cardiac structure and function compared with placebo. Decrease in left atrial volume at follow-up was associated with a lower risk of subsequent occurrence of the primary outcome. CONCLUSIONS: Twelve to 18 months of spironolactone therapy was not associated with alterations in cardiac structure or function in patients with heart failure with preserved ejection fraction. Reduction in left atrial volume at follow-up was associated with a lower risk of subsequent occurrence of the primary composite outcome. CLINICAL TRIAL REGISTRATION: URL: http:///www.clinicaltrials.gov. Unique identifier: NCT00094302.
Shah et al. (Sat,) conducted a rct in Heart failure with preserved ejection fraction (n=239). Spironolactone vs. Placebo was evaluated on Measures of cardiac structure and function. Spironolactone therapy for 12 to 18 months did not alter cardiac structure or function compared with placebo in HFpEF, though reduced left atrial volume predicted lower risk of the primary outcome.