Spironolactone effect on cardiac structure and function of patients with heart failure and preserved ejection fraction: a pooled analysis of three randomized trials

Ferreira, J. P. et al. (2023) Spironolactone effect on cardiac structure and function of patients with heart failure and preserved ejection fraction: a pooled analysis of three randomized trials. European Journal of Heart Failure, 25(1), pp. 108-113. (doi: 10.1002/ejhf.2726) (PMID:36303266)

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Abstract

Background: Spironolactone is currently used in a large proportion of patients with heart failure and preserved ejection fraction (HFpEF), yet its effects on cardiac structure and function in a large population has not been well established. Aims: To study the impact of spironolactone on key echocardiographic parameters in HFpEF. Methods: Individual-patient-data meta-analysis of three randomized trials (HOMAGE, ALDO-DHF, and TOPCAT) comparing spironolactone (9-12 months exposure) to placebo (or control) on the changes of left atrial volume indexed (LAVi), left ventricular mass indexed (LVMi), inter-ventricular septum (IVS) thickness, E/e' ratio, and left ventricular ejection fraction (LVEF) among patients with stage B (HOMAGE) or C (ALDO-DHF and TOPCAT) HFpEF. Analysis of covariance were used to test the effect of spironolactone on echocardiographic changes. Results: A total of 984 patients were included in this analysis: HOMAGE=452 (45.9%), ALDO-DHF=398 (40.4%), and TOPCAT=134 (13.6%). The pooled-cohort patient's median age was 71 (66-77)years and 39% were women. Median LAVi was 29 (24-35)ml/m2, LVMi 100 (84-118)g/m2, IVS thickness 12 (10-13)mm, E/e' ratio 11 (9-13), and LVEF 64 (59-69)%. Spironolactone reduced LAVi by -1.1 (-2.0 to -0.1)ml/m2, P=0.03; LVMi by -3.6 (-6.4 to -0.8)g/m2, P=0.01; IVS thickness by -0.2 (-0.3 to -0.1)mm, P=0.01; E/e' ratio by -1.3 (-2.4 to -0.2), P =0.02; and increased LVEF by 1.7 (0.8 to 2.6)%, P <0.01. No treatment-by-study heterogeneity was found except for E/e' ratio with a larger effect in ALDO-DHF and TOPCAT (interactionP<0.01). Conclusions: Spironolactone improved cardiac structure and function of patients with HFpEF.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Cleland, Professor John and Ferreira, Mr Joao Pedro and Pellicori, Dr Pierpaolo
Authors: Ferreira, J. P., Cleland, J. G., Girerd, N., Bozec, E., Rossignol, P., Pellicori, P., Cosmi, F., Mariottoni, B., Solomon, S. D., Pitt, B., Pfeffer, M. A., Shah, A. M., Petutschnigg, J., Pieske, B., Edelmann, F., and Zannad, F.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
Journal Name:European Journal of Heart Failure
Publisher:Wiley
ISSN:1388-9842
ISSN (Online):1879-0844
Published Online:27 October 2022
Copyright Holders:Copyright © 2022 European Society of Cardiology
First Published:First published in European Journal of Heart Failure 25(1): 108-113
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
190666HOMAGE: Heart OMics in AGEingChristian DellesEuropean Commission (EC)305507Institute of Cardiovascular & Medical Sciences