Portal de investigação
Spironolactone effect on cardiac structure and function of patients with heart failure and preserved ejection fraction: a pooled analysis of three randomized trials
Data de publicação:
Data Ahead of Print:
Autores da FMUP
Participantes de fora da FMUP
- Cleland, JG
- Girerd, N
- Bozec, E
- Rossignol, P
- Pellicori, P
- Cosmi, F
- Mariottoni, B
- Solomon, SD
- Pitt, B
- Pfeffer, MA
- Shah, AM
- Petutschnigg, J
- Pieske, B
- Edelmann, F
- Zannad, F
Unidades de investigação
Abstract
Aims Spironolactone is currently used in a large proportion of patients with heart failure and preserved ejection fraction (HFpEF), yet its effect on cardiac structure and function in a large population has not been well established. The aim of this study was to evaluate the impact of spironolactone on key echocardiographic parameters in HFpEF. Methods and results An individual-patient-data meta-analysis of three randomized trials (HOMAGE, Aldo-DHF, and TOPCAT) was performed comparing spironolactone (9-12 month exposure) to placebo (or control) for the changes in left atrial volume index (LAVi), left ventricular mass index (LVMi), interventricular septum (IVS) thickness, E/e ' ratio, and left ventricular ejection fraction (LVEF) among patients with stage B (HOMAGE) or C (Aldo-DHF and TOPCAT) HFpEF. Analysis of covariance was used to test the effect of spironolactone on echocardiographic changes. A total of 984 patients were included in this analysis: 452 (45.9%) from HOMAGE, 398 (40.4%) from Aldo-DHF, and 134 (13.6%) from TOPCAT. The pooled-cohort patient's median age was 71 (66-77) years and 39% were women. Median LAVi was 29 (24-35) ml/m(2), LVMi 100 (84-118) g/m(2), IVS thickness 12 (10-13) mm, E/e ' ratio 11 (9-13), and LVEF 64 (59-69)%. Spironolactone reduced LAVi by -1.1 (-2.0 to -0.1) ml/m(2) (p = 0.03); LVMi by -3.6 (-6.4 to -0.8) g/m(2) (p = 0.01); IVS thickness by -0.2 (-0.3 to -0.1) mm (p = 0.01); E/e ' ratio by -1.3 (-2.4 to -0.2) (p = 0.02); and increased LVEF by 1.7 (0.8-2.6)% (p < 0.01). No treatment-by-study heterogeneity was found except for E/e ' ratio with a larger effect in Aldo-DHF and TOPCAT (interaction p < 0.01). Conclusions Spironolactone improved cardiac structure and function of patients with HFpEF.
Dados da publicação
- ISSN/ISSNe:
- 1388-9842, 1879-0844
- Tipo:
- Article
- Páginas:
- 108-113
- DOI:
- 10.1002/ejhf.2726
- Link para outro recurso:
- www.scopus.com
European Journal of Heart Failure Wiley-Blackwell
Citações Recebidas na Web of Science: 9
Citações Recebidas na Scopus: 18
Documentos
- Não há documentos
Filiações
Keywords
- Spironolactone; HFpEF; Echocardiography; Cardiac structure and function; Treatment effect
Financiamento
Proyectos asociados
Dapagliflozin, Spironolactone or Both for HFpEF (SOGALDI-PEF) - NCT05676684
Investigador Principal: João Pedro Melo Marques Pinho Ferreira
Ensaio Clínico Académico (SOGALDI-PEF) . AstraZeneca . 2022
Citar a publicação
Ferreira JP,Cleland JG,Girerd N,Bozec E,Rossignol P,Pellicori P,Cosmi F,Mariottoni B,Solomon SD,Pitt B,Pfeffer MA,Shah AM,Petutschnigg J,Pieske B,Edelmann F,Zannad F. Spironolactone effect on cardiac structure and function of patients with heart failure and preserved ejection fraction: a pooled analysis of three randomized trials. Eur. J. Heart Fail. 2023. 25. (1):p. 108-113. IF:18,200. (1).
