Shah Amil M, Claggett Brian, Sweitzer Nancy K, Shah Sanjiv J, Deswal Anita, Anand Inder S, Fleg Jerome L, Pitt Bertram, Pfeffer Marc A, Solomon Scott D
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.).
Circ Heart Fail. 2015 Nov;8(6):1052-8. doi: 10.1161/CIRCHEARTFAILURE.115.002249. Epub 2015 Oct 16.
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.
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.
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.
URL: http:///www.clinicaltrials.gov. Unique identifier: NCT00094302.
关于醛固酮拮抗剂治疗对射血分数保留的心力衰竭患者心脏结构和功能的影响，以及射血分数保留的心力衰竭患者心脏结构和功能变化的预后相关性，现有数据有限。
在醛固酮拮抗剂治疗射血分数保留的心力衰竭（TOPCAT）试验中，对239例射血分数保留的心力衰竭患者（左心室射血分数[LVEF]≥45%）在基线及12至18个月随访时通过定量超声心动图评估心脏结构和功能。在整个研究人群中评估螺内酯治疗对心脏结构和功能指标的影响，并将超声心动图指标的变化与心血管死亡、心力衰竭住院或心脏骤停未遂的主要复合结局的后续发生情况相关联。与安慰剂相比，螺内酯与心脏结构和功能的改变无关。随访时左心房容积减小与后续发生主要结局的风险较低相关。
在射血分数保留的心力衰竭患者中，12至18个月的螺内酯治疗与心脏结构或功能的改变无关。随访时左心房容积减小与后续发生主要复合结局的风险较低相关。
网址：http:///www.clinicaltrials.gov。唯一标识符：NCT00094302。
