Prognostic Importance of Changes in Cardiac Structure and Function in Heart Failure With Preserved Ejection Fraction and the Impact of Spironolactone
Prognostic Importance of Changes in Cardiac Structure and Function in Heart Failure With Preserved Ejection Fraction and the Impact of Spironolactone
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DOI：
10.1161/circheartfailure.115.002249
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发表时间：
2015-11-01
影响因子：
9.7
通讯作者：
Solomon, Scott D.
中科院分区：
文献类型：
--
作者：
Shah, Amil M.;Claggett, Brian;Solomon, Scott D.
背景--关于在射血分数保留的心力衰竭患者中使用醛固酮拮抗剂治疗对心脏结构和功能的影响，以及在射血分数保留的心力衰竭患者中心脏结构和功能的变化与预后的相关性，目前的数据有限。方法和结果：在239名使用醛固酮拮抗剂(TOPCAT)试验治疗心功能保留的心力衰竭患者中，通过定量超声心动图评估了基线和12-18个月随访时的心脏结构和功能。螺内酯治疗对心脏结构和功能测量的影响在整个研究人群中进行了评估，超声心动图测量的变化与随后发生的心血管死亡、心力衰竭住院或心脏骤停的主要综合结果相关。与安慰剂相比，螺内酯与心脏结构和功能的改变无关。结论：心力衰竭患者接受螺内酯治疗12个月至18个月与心脏结构或功能的改变无关。随访时左心房容量的减少与随后发生初级复合结局的风险较低相关。
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.