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Prognostic Importance of Changes in Cardiac Structure and Function in Heart Failure With Preserved Ejection Fraction and the Impact of Spironolactone.
Circ Heart Fail. 2015 Nov; 8(6):1052-8.CH

Abstract

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.

Authors+Show Affiliations

From the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., M.A.P., S.D.S.); Division of Cardiology, Sarver Heart Center, University of Arizona College of Medicine, Tucson, AZ (N.K.S.); Cardiology Division, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Cardiology Division, Michael E. DeBakey VA Medical Center & Baylor College of Medicine, Houston, TX (A.D.); Cardiovascular Division, VA Medical Center, Minneapolis, MN (I.S.A.); National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F.); and Cardiology Division, University of Michigan School of Medicine, Ann Arbor, MI (B.P.). ashah11@partners.org.From the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., M.A.P., S.D.S.); Division of Cardiology, Sarver Heart Center, University of Arizona College of Medicine, Tucson, AZ (N.K.S.); Cardiology Division, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Cardiology Division, Michael E. DeBakey VA Medical Center & Baylor College of Medicine, Houston, TX (A.D.); Cardiovascular Division, VA Medical Center, Minneapolis, MN (I.S.A.); National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F.); and Cardiology Division, University of Michigan School of Medicine, Ann Arbor, MI (B.P.).From the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., M.A.P., S.D.S.); Division of Cardiology, Sarver Heart Center, University of Arizona College of Medicine, Tucson, AZ (N.K.S.); Cardiology Division, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Cardiology Division, Michael E. DeBakey VA Medical Center & Baylor College of Medicine, Houston, TX (A.D.); Cardiovascular Division, VA Medical Center, Minneapolis, MN (I.S.A.); National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F.); and Cardiology Division, University of Michigan School of Medicine, Ann Arbor, MI (B.P.).From the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., M.A.P., S.D.S.); Division of Cardiology, Sarver Heart Center, University of Arizona College of Medicine, Tucson, AZ (N.K.S.); Cardiology Division, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Cardiology Division, Michael E. DeBakey VA Medical Center & Baylor College of Medicine, Houston, TX (A.D.); Cardiovascular Division, VA Medical Center, Minneapolis, MN (I.S.A.); National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F.); and Cardiology Division, University of Michigan School of Medicine, Ann Arbor, MI (B.P.).From the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., M.A.P., S.D.S.); Division of Cardiology, Sarver Heart Center, University of Arizona College of Medicine, Tucson, AZ (N.K.S.); Cardiology Division, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Cardiology Division, Michael E. DeBakey VA Medical Center & Baylor College of Medicine, Houston, TX (A.D.); Cardiovascular Division, VA Medical Center, Minneapolis, MN (I.S.A.); National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F.); and Cardiology Division, University of Michigan School of Medicine, Ann Arbor, MI (B.P.).From the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., M.A.P., S.D.S.); Division of Cardiology, Sarver Heart Center, University of Arizona College of Medicine, Tucson, AZ (N.K.S.); Cardiology Division, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Cardiology Division, Michael E. DeBakey VA Medical Center & Baylor College of Medicine, Houston, TX (A.D.); Cardiovascular Division, VA Medical Center, Minneapolis, MN (I.S.A.); National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F.); and Cardiology Division, University of Michigan School of Medicine, Ann Arbor, MI (B.P.).From the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., M.A.P., S.D.S.); Division of Cardiology, Sarver Heart Center, University of Arizona College of Medicine, Tucson, AZ (N.K.S.); Cardiology Division, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Cardiology Division, Michael E. DeBakey VA Medical Center & Baylor College of Medicine, Houston, TX (A.D.); Cardiovascular Division, VA Medical Center, Minneapolis, MN (I.S.A.); National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F.); and Cardiology Division, University of Michigan School of Medicine, Ann Arbor, MI (B.P.).From the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., M.A.P., S.D.S.); Division of Cardiology, Sarver Heart Center, University of Arizona College of Medicine, Tucson, AZ (N.K.S.); Cardiology Division, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Cardiology Division, Michael E. DeBakey VA Medical Center & Baylor College of Medicine, Houston, TX (A.D.); Cardiovascular Division, VA Medical Center, Minneapolis, MN (I.S.A.); National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F.); and Cardiology Division, University of Michigan School of Medicine, Ann Arbor, MI (B.P.).From the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., M.A.P., S.D.S.); Division of Cardiology, Sarver Heart Center, University of Arizona College of Medicine, Tucson, AZ (N.K.S.); Cardiology Division, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Cardiology Division, Michael E. DeBakey VA Medical Center & Baylor College of Medicine, Houston, TX (A.D.); Cardiovascular Division, VA Medical Center, Minneapolis, MN (I.S.A.); National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F.); and Cardiology Division, University of Michigan School of Medicine, Ann Arbor, MI (B.P.).From the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., M.A.P., S.D.S.); Division of Cardiology, Sarver Heart Center, University of Arizona College of Medicine, Tucson, AZ (N.K.S.); Cardiology Division, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Cardiology Division, Michael E. DeBakey VA Medical Center & Baylor College of Medicine, Houston, TX (A.D.); Cardiovascular Division, VA Medical Center, Minneapolis, MN (I.S.A.); National Heart, Lung, and Blood Institute, Bethesda, MD (J.L.F.); and Cardiology Division, University of Michigan School of Medicine, Ann Arbor, MI (B.P.).

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26475142

Citation

Shah, Amil M., et al. "Prognostic Importance of Changes in Cardiac Structure and Function in Heart Failure With Preserved Ejection Fraction and the Impact of Spironolactone." Circulation. Heart Failure, vol. 8, no. 6, 2015, pp. 1052-8.
Shah AM, Claggett B, Sweitzer NK, et al. Prognostic Importance of Changes in Cardiac Structure and Function in Heart Failure With Preserved Ejection Fraction and the Impact of Spironolactone. Circ Heart Fail. 2015;8(6):1052-8.
Shah, A. M., Claggett, B., Sweitzer, N. K., Shah, S. J., Deswal, A., Anand, I. S., Fleg, J. L., Pitt, B., Pfeffer, M. A., & Solomon, S. D. (2015). Prognostic Importance of Changes in Cardiac Structure and Function in Heart Failure With Preserved Ejection Fraction and the Impact of Spironolactone. Circulation. Heart Failure, 8(6), 1052-8. https://doi.org/10.1161/CIRCHEARTFAILURE.115.002249
Shah AM, et al. Prognostic Importance of Changes in Cardiac Structure and Function in Heart Failure With Preserved Ejection Fraction and the Impact of Spironolactone. Circ Heart Fail. 2015;8(6):1052-8. PubMed PMID: 26475142.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prognostic Importance of Changes in Cardiac Structure and Function in Heart Failure With Preserved Ejection Fraction and the Impact of Spironolactone. AU - Shah,Amil M, AU - Claggett,Brian, AU - Sweitzer,Nancy K, AU - Shah,Sanjiv J, AU - Deswal,Anita, AU - Anand,Inder S, AU - Fleg,Jerome L, AU - Pitt,Bertram, AU - Pfeffer,Marc A, AU - Solomon,Scott D, Y1 - 2015/10/16/ PY - 2015/04/09/received PY - 2015/10/07/accepted PY - 2015/10/18/entrez PY - 2015/10/18/pubmed PY - 2016/3/2/medline KW - clinical trial KW - echocardiography KW - heart failure with preserved ejection fraction KW - spironolactone SP - 1052 EP - 8 JF - Circulation. Heart failure JO - Circ Heart Fail VL - 8 IS - 6 N2 - 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. SN - 1941-3297 UR - https://www.unboundmedicine.com/medline/citation/26475142/Prognostic_Importance_of_Changes_in_Cardiac_Structure_and_Function_in_Heart_Failure_With_Preserved_Ejection_Fraction_and_the_Impact_of_Spironolactone_ L2 - http://www.ahajournals.org/doi/full/10.1161/CIRCHEARTFAILURE.115.002249?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -