Secondary endpoints, including systolic blood pressure and some measures of cardiac function and remodeling, were improved in the spironolactone group. Spironolactone significantly improved diastolic function compared to placebo ( p<0.001), but had no effect on exercise capacity ( p=0.81) at 12 months after randomization.
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Those with significant coronary artery disease, myocardial infarction or bypass surgery within 3 months, clinically significant pulmonary disease, and severe renal dysfunction were excluded.
#Topcat trial
The TOPCAT trial was a large randomized, double-blinded trial enrolling 3445 patients with heart failure and a left ventricular ejection fraction (LVEF) of 45% or greater, comparing the use of spironolactone (15-45 mg daily) with placebo.(10) Patients had at least one sign and symptom of heart failure, and a serum potassium level 50%, echocardiographic evidence of diastolic dysfunction, and an exercise capacity of <25 mL/kg/min. Eplerenone and spironolactone) were demonstrated to reduce mortality and hospitalizations in patients with HFrEF.(7-9) Previously, in the RALES, EPHESUS, and EMPHASIS trials, MRAs (ie. The recently published TOPCAT and ALDO-DHF trials provide new insight into the role of mineralocorticoid receptor antagonists (MRAs) in the management of HFpEF. The PEP-CHF, CHARM-Preserved, and I-PRESERVE trials evaluated ACE inhibitors and ARBs in the management of HFpEF and identified no mortality reduction but fewer hospital admissions.(3-5) In the OPTIMIZE-HF registry, beta-blockers were ineffective in reducing mortality or hospitalization in patients with HFpEF.(6) Therefore, current guidelines offer no specific recommendations for treating patients with HFpEF, apart from the managing their symptoms, medical comorbidities, and cardiovascular risk.(2) Up to 50% of patients presenting with signs and symptoms of heart failure will have a preserved ejection fraction (HFpEF or diastolic dysfunction).(1) However, there is a lack of evidence for effective therapies in the management of HFpEF.īeta-blockers, angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and mineralocorticoid receptor antagonists (MRAs) have all proven effective in the treatment of heart failure with reduced ejection fraction (HFrEF or systolic dysfunction).(2) However, clinical trials evaluating the treatment of HFpEF have not yielded significant improvements in clinical outcomes. In the United States, heart failure is commonly encountered in the family physician’s office, and accounts for nearly 4 million outpatient visits per year, with up to one in 9 deaths listing heart failure as a contributing cause. There are approximately 500,000 Canadians living with heart failure, although this climbs to more than 10% of patients older than 65 years. Treatments or recommendations in this article are unrelated to products/services/treatments involved in disclosure statements Recommendations are consistent with published guidelines (Canadian Cardiovascular Society CCS 2014 HF Guidelines)Ĭ. Mustafa Toma has previous received honoraria from Pfizer Canada.Ī. Christopher Cheung, ( biography and disclosures)ĭisclosures: Dr.
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Mustafa Toma ( biography and disclosure) and Dr.