Voors Adriaan A
Universitair Medisch Centrum Groningen, afd. Cardiologie, Groningen.
Ned Tijdschr Geneeskd. 2014;158:A7805.
The treatment of chronic systolic heart failure has shown important improvements, but there are no evidence-based medical treatment options for patients with diastolic heart failure. A recent elaborate study, the TOPCAT trial, failed to show a beneficial effect of spironolactone on the primary composite endpoint of cardiovascular death or hospital admission for heart failure in patients with heart failure and preserved ejection fraction (HFpEF). After ACE inhibitors and angiotensin receptor blockers, this is the third group of medications that previously showed a beneficial effect in patients with heart failure and a reduced ejection fraction (HFrEF), but failed in HFpEF patients. The difficulties in the study design and in interpreting the results of the TOPCAT study may contribute to this negative conclusion. However, a better understanding of the pathophysiology of HFpEF is needed to find strategies that improve the clinical outcome in patients with diastolic heart failure.
慢性收缩性心力衰竭的治疗已取得重要进展，但对于舒张性心力衰竭患者，尚无基于证据的药物治疗方案。最近一项精心设计的研究——TOPCAT试验，未能显示螺内酯对射血分数保留的心衰（HFpEF）患者心血管死亡或因心力衰竭住院的主要复合终点有有益作用。继血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂之后，这是第三类先前在射血分数降低的心衰（HFrEF）患者中显示有益作用，但在HFpEF患者中失败的药物。TOPCAT研究在设计和结果解读方面的困难可能导致了这一负面结论。然而，需要更好地理解HFpEF的病理生理学，以找到改善舒张性心力衰竭患者临床结局的策略。
