Outcomes of Spironolactone Withdrawal in Dilated Cardiomyopathy With Improved Ejection Fraction.
Outcomes of Spironolactone Withdrawal in Dilated Cardiomyopathy With Improved Ejection Fraction.
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DOI：
10.3389/fcvm.2021.725399
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发表时间：
2021
影响因子：
3.6
通讯作者：
Jin W
中科院分区：
文献类型：
--
作者：
Chen Y;Qiu Z;Jiang J;Su X;Huang F;Tang J;Jin W
背景：对于射血分数改善的扩张型心肌病患者，停用螺内酯的可行性尚不清楚。这项研究试图确定在这种情况下是否可以安全地停用螺内酯。方法：使用心力衰竭试验风险评估和管理数据库(NCT02998788)，将连续的特发性扩张型心肌病患者和出院时服用安体舒通的患者纳入这一前瞻性观察队列。那些左心室射血分数(≥)绝对值改善10%，第二次测量左心室射血分数和GT；40%的患者将选择是否继续接受螺内酯治疗，并纳入最终分析。主要终点是扩张型心肌病在12个月内复发，定义为LVEF减少10%以上，LVESVi增加15%或更多，NT-proBNP增加2倍，或临床表现为心力衰竭。结果：70名患者的射血分数得到改善并进入最终分析，其中30名患者选择继续服用螺内酯，40名患者决定停用。在主要终点分析中，停药组的23名患者(58%)和继续组的4名患者(13%)复发(相对复发风险：4.31；95%可信区间：1.67-11.11；p<；0.001)。停药组患者的症状加重程度明显高于继续组。没有记录到第二个安全端点。停用螺内酯后，心脏结构参数不再有改善，而继续服药组持续改善。结论：大多数射血分数改善的扩张型心肌病患者停用螺内酯后会复发。在尝试停用螺内酯之前，应权衡这些结果。
Background: The feasibility of spironolactone withdrawal in dilated cardiomyopathy patients with improved ejection fraction remains unknown. This study sought to determine whether spironolactone can be withdrawn safely in this circumstance. Methods: Consecutive patients with idiopathic dilated cardiomyopathy and prescribed spironolactone at discharge were included in this prospective, observational cohort using the Risk Evaluation and Management in Heart Failure Trial (NCT02998788) database. Those patients who experienced an absolute left ventricular ejection fraction (LVEF) improvement ≥10% and a second measurement of LVEF >40% would choose whether to continue spironolactone therapy and be included in final analysis. The primary endpoint was dilated cardiomyopathy relapse within 12 months, defined as a more than 10% reduction in LVEF, a 15% or greater increase in LVESVi, a 2-fold rise in NT-proBNP, or clinical signs of heart failure. Results: Seventy patients achieved an ejection fraction improvement and were included in the final analysis, of whom 30 chose to continue spironolactone and 40 decided to withdraw. In primary endpoint analysis, 23 (58%) patients from the withdrawal group and 4 (13%) patients from the continuation group relapsed (relative risk for relapse: 4.31; 95% CI: 1.67–11.11; p < 0.001). Patients from the withdrawal group experienced more symptom aggravation than the continuation group. No secondary safety endpoint was recorded. Improvements in cardiac structure parameters were no longer observed after spironolactone withdrawal, while improvements persisted in continuation group. Conclusions: Most dilated cardiomyopathy patients with improved ejection fraction will relapse after spironolactone withdrawal. These results should be weighed before spironolactone withdrawal was attempted.
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影响因子：
39.3
作者：
Cleland JGF;Ferreira JP;Mariottoni B;Pellicori P;Cuthbert J;Verdonschot JAJ;Petutschnigg J;Ahmed FZ;Cosmi F;Brunner La Rocca HP;Mamas MA;Clark AL;Edelmann F;Pieske B;Khan J;McDonald K;Rouet P;Staessen JA;Mujaj B;González A;Diez J;Hazebroek M;Heymans S;Latini R;Grojean S;Pizard A;Girerd N;Rossignol P;Collier TJ;Zannad F;HOMAGE Trial Committees and Investigators
通讯作者：
HOMAGE Trial Committees and Investigators
影响因子：
18.2
作者：
Ferreira, Joao Pedro;Rossignol, Patrick;Zannad, Faiez
通讯作者：
Zannad, Faiez
影响因子：
5.4
作者：
St John Sutton M;Cerkvenik J;Borlaug BA;Daubert C;Gold MR;Ghio S;Chirinos JA;Linde C;Ky B
通讯作者：
Ky B
影响因子：
24
作者：
Greene, Stephen J.;Butler, Javed;Fonarow, Gregg C.
通讯作者：
Fonarow, Gregg C.
影响因子：
39.3
作者：
McMurray, John J. V.;Adamopoulos, Stamatis;Ponikowski, Piotr
通讯作者：
Ponikowski, Piotr