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
- PubMed:
- 36303266
- 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
Projetos associados
Dapagliflozin, Spironolactone or Both for HFpEF (SOGALDI-PEF) - NCT05676684
Investigador Principal: João Pedro Melo Marques Pinho Ferreira
Ensaio Clínico Académico (SOGALDI-PEF) . AstraZeneca . 2022
