Spironolactone for Management of Heart Failure with Preserved Ejection Fraction: Whither to After TOPCAT?

摘要: Mineralocorticoid receptor antagonists (MRAs) represent an attractive class of drugs for the treatment heart failure with preserved ejection fraction (HFpEF) because deleterious cardiovascular effects aldosterone and MRAs combat myocardial fibrosis improve cardiac structure/function vascular health. Recently, Treatment Preserved Cardiac Function Heart Failure Aldosterone Antagonist (TOPCAT) study, a randomized, double-blind clinical trial spironolactone versus placebo, was conducted in 3445 patients symptomatic HFpEF. Although considered by some to be negative trial, TOPCAT demonstrated that decreases hospitalizations Furthermore, pre-specified subgroup analysis geographic region uncovered concerning findings from Russia/Georgia, questioning (1) whether correct were enrolled this (2) actually received study drug. In Americas, clearly superior placebo reducing events. Given these data TOPCAT, basic science evidence role HFpEF, results other MRA trials we advocate using HFpEF close monitoring potassium renal function.