Spironolactone effect on cardiac structure and function of patients with heart failure and preserved ejection fraction: a pooled analysis of three randomized trials.
Cardiac structure and function
Echocardiography
HFpEF
Spironolactone
Treatment effect
Journal
European journal of heart failure
ISSN: 1879-0844
Titre abrégé: Eur J Heart Fail
Pays: England
ID NLM: 100887595
Informations de publication
Date de publication:
01 2023
01 2023
Historique:
revised:
12
09
2022
received:
03
08
2022
accepted:
23
10
2022
pubmed:
29
10
2022
medline:
1
2
2023
entrez:
28
10
2022
Statut:
ppublish
Résumé
Spironolactone is currently used in a large proportion of patients with heart failure and preserved ejection fraction (HFpEF), yet its effect on cardiac structure and function in a large population has not been well established. The aim of this study was to evaluate the impact of spironolactone on key echocardiographic parameters in HFpEF. An individual-patient-data meta-analysis of three randomized trials (HOMAGE, Aldo-DHF, and TOPCAT) was performed comparing spironolactone (9-12 month exposure) to placebo (or control) for the changes in left atrial volume index (LAVi), left ventricular mass index (LVMi), interventricular 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 was used to test the effect of spironolactone on echocardiographic changes. A total of 984 patients were included in this analysis: 452 (45.9%) from HOMAGE, 398 (40.4%) from Aldo-DHF, and 134 (13.6%) from TOPCAT. The pooled-cohort patient's median age was 71 (66-77) years and 39% were women. Median LAVi was 29 (24-35) ml/m Spironolactone improved cardiac structure and function of patients with HFpEF.
Substances chimiques
Spironolactone
27O7W4T232
Mineralocorticoid Receptor Antagonists
0
Types de publication
Meta-Analysis
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
108-113Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2022 European Society of Cardiology.
Références
Pitt B, Pfeffer MA, Assmann SF, Boineau R, Anand IS, Claggett B, et al.; TOPCAT Investigators. Spironolactone for heart failure with preserved ejection fraction. N Engl J Med. 2014;370:1383-92.
Solomon SD, Claggett B, Lewis EF, Desai A, Anand I, Sweitzer NK, et al.; TOPCAT Investigators. Influence of ejection fraction on outcomes and efficacy of spironolactone in patients with heart failure with preserved ejection fraction. Eur Heart J. 2015;37:455-62.
Ferreira JP, Packer M, Butler J, Zannad F. Reconsidering the ejection fraction centric view of pharmacologic treatment for heart failure. Eur J Heart Fail. 2022;24:1148-53.
Edelmann F, Wachter R, Schmidt AG, Kraigher-Krainer E, Colantonio C, Kamke W, et al.; Aldo-DHF Investigators. Effect of spironolactone on diastolic function and exercise capacity in patients with heart failure with preserved ejection fraction: the Aldo-DHF randomized controlled trial. JAMA. 2013;309:781-91.
Cleland JGF, Ferreira JP, Mariottoni B, Pellicori P, Cuthbert J, Verdonschot JAJ, et al.; HOMAGE Trial Committees and Investigators. The effect of spironolactone on cardiovascular function and markers of fibrosis in people at increased risk of developing heart failure: the Heart ‘OMics’ in AGEing (HOMAGE) randomized clinical trial. Eur Heart J. 2021;42:684-96.
Kobayashi M, Girerd N, Ferreira JP, Kevin D, Huttin O, González A, et al.; HOMAGE Trial Committees and Investigators. The association between markers of type I collagen synthesis and echocardiographic response to spironolactone in patients at risk of heart failure: findings from the HOMAGE trial. Eur J Heart Fail. 2022;24:1559-68.
Shah AM, Claggett B, Sweitzer NK, Shah SJ, Deswal A, Anand IS, et al. Prognostic importance of changes in cardiac structure and function in heart failure with preserved ejection fraction and the impact of spironolactone. Circ Heart Fail. 2015;8:1052-8.
Pellicori P, Ferreira JP, Mariottoni B, Brunner-La Rocca HP, Ahmed FZ, Verdonschot J, et al. Effects of spironolactone on serum markers of fibrosis in people at high risk of developing heart failure: rationale, design and baseline characteristics of a proof-of-concept, randomised, precision-medicine, prevention trial. The Heart OMics in AGing (HOMAGE) trial. Eur J Heart Fail. 2020;22:1711-23.
Pfeffer MA, Claggett B, Assmann SF, Boineau R, Anand IS, Clausell N, et al. Regional variation in patients and outcomes in the Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist (TOPCAT) trial. Circulation. 2015;131:34-42.
Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, et al.; Chamber Quantification Writing Group; American Society of Echocardiography's Guidelines and Standards Committee; European Association of Echocardiography. Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005;18:1440-63.
da Costa BR, Juni P. Systematic reviews and meta-analyses of randomized trials: principles and pitfalls. Eur Heart J. 2014;35:3336-45.
Riley RD, Lambert PC, Abo-Zaid G. Meta-analysis of individual participant data: rationale, conduct, and reporting. BMJ. 2010;340:c221.
Gupta S, Matulevicius SA, Ayers CR, Berry JD, Patel PC, Markham DW, et al. Left atrial structure and function and clinical outcomes in the general population. Eur Heart J. 2013;34:278-85.
Pellicori P, Zhang J, Lukaschuk E, Joseph AC, Bourantas CV, Loh H, et al. Left atrial function measured by cardiac magnetic resonance imaging in patients with heart failure: clinical associations and prognostic value. Eur Heart J. 2015;36:733-42.
Hoit BD. Left atrial size and function: role in prognosis. J Am Coll Cardiol. 2014;63:493-505.
Inciardi RM, Claggett B, Minamisawa M, Shin SH, Selvaraj S, Gonçalves A, et al. Association of left atrial structure and function with heart failure in older adults. J Am Coll Cardiol. 2022;79:1549-61.
Rossi A, Gheorghiade M, Triposkiadis F, Solomon SD, Pieske B, Butler J. Left atrium in heart failure with preserved ejection fraction: structure, function, and significance. Circ Heart Fail. 2014;7:1042-9.
Inciardi RM, Bonelli A, Biering-Sorensen T, Cameli M, Pagnesi M, Lombardi CM, et al. Left atrial disease and left atrial reverse remodelling across different stages of heart failure development and progression: a new target for prevention and treatment. Eur J Heart Fail. 2022;24:959-75.
Thomas L, Abhayaratna WP. Left atrial reverse remodeling: mechanisms, evaluation, and clinical significance. JACC Cardiovasc Imaging. 2017;10:65-77.
Swedberg K, Zannad F, McMurray JJ, Krum H, van Veldhuisen DJ, Shi H, et al. Eplerenone and atrial fibrillation in mild systolic heart failure: results from the EMPHASIS-HF (Eplerenone in Mild Patients Hospitalization And SurvIval Study in Heart Failure) study. J Am Coll Cardiol. 2012;59:1598-603.
Filippatos G, Bakris GL, Pitt B, Agarwal R, Rossing P, Ruilope LM, et al.; FIDELIO-DKD Investigators. Finerenone reduces new-onset atrial fibrillation in patients with chronic kidney disease and type 2 diabetes. J Am Coll Cardiol. 2021;78:142-52.
Ovchinnikov A, Belyavskiy E, Potekhina A, Ageev F. Asymptomatic left ventricular hypertrophy is a potent risk factor for the development of HFpEF but not HFrEF: results of a retrospective cohort study. J Clin Med. 2022;11:3885.
Drazner MH. The transition from hypertrophy to failure: how certain are we? Circulation. 2005;112:936-8.
Shah AM, Cikes M, Prasad N, Li G, Getchevski S, Claggett B, et al.; PARAGON-HF Investigators. Echocardiographic features of patients with heart failure and preserved left ventricular ejection fraction. J Am Coll Cardiol. 2019;74:2858-73.
Yamanaka S, Sakata Y, Nochioka K, Miura M, Kasahara S, Sato M, et al.; CHART-2 Investigators. Prognostic impacts of dynamic cardiac structural changes in heart failure patients with preserved left ventricular ejection fraction. Eur J Heart Fail. 2020;22:2258-68.
Schlaich MP, Schmieder RE. Left ventricular hypertrophy and its regression: pathophysiology and therapeutic approach: focus on treatment by antihypertensive agents. Am J Hypertens. 1998;11:1394-404.
Schmieder RE, Martus P, Klingbeil A. Reversal of left ventricular hypertrophy in essential hypertension. A meta-analysis of randomized double-blind studies. JAMA. 1996;275:1507-13.
Brown AJM, Gandy S, McCrimmon R, Houston JG, Struthers AD, Lang CC. A randomized controlled trial of dapagliflozin on left ventricular hypertrophy in people with type two diabetes: the DAPA-LVH trial. Eur Heart J. 2020;41:3421-32.
Edwards NC, Steeds RP, Stewart PM, Ferro CJ, Townend JN. Effect of spironolactone on left ventricular mass and aortic stiffness in early-stage chronic kidney disease: a randomized controlled trial. J Am Coll Cardiol. 2009;54:505-12.
Schneider A, Schwab J, Karg MV, Kalizki T, Reinold A, Schneider MP, et al. Low-dose eplerenone decreases left ventricular mass in treatment-resistant hypertension. J Hypertens. 2017;35:1086-92.
Pitt B, Reichek N, Willenbrock R, Zannad F, Phillips RA, Roniker B, et al. Effects of eplerenone, enalapril, and eplerenone/enalapril in patients with essential hypertension and left ventricular hypertrophy: the 4E-left ventricular hypertrophy study. Circulation. 2003;108:1831-8.
Degre S, Detry JM, Unger P, Cosyns J, Brohet C, Kormoss N. Effects of spironolactone-altizide on left ventricular hypertrophy. Acta Cardiol. 1998;53:261-7.
Wang J, Nagueh SF. Echocardiographic assessment of left ventricular filling pressures. Heart Fail Clin. 2008;4:57-70.
Mullens W, Borowski AG, Curtin RJ, Thomas JD, Tang WH. Tissue Doppler imaging in the estimation of intracardiac filling pressure in decompensated patients with advanced systolic heart failure. Circulation. 2009;119:62-70.
Geske JB, Sorajja P, Nishimura RA, Ommen SR. Evaluation of left ventricular filling pressures by Doppler echocardiography in patients with hypertrophic cardiomyopathy: correlation with direct left atrial pressure measurement at cardiac catheterization. Circulation. 2007;116:2702-8.
Kosmala W, Przewlocka-Kosmala M, Marwick TH. Association of active and passive components of LV diastolic filling with exercise intolerance in heart failure with preserved ejection fraction: mechanistic insights from spironolactone response. JACC Cardiovasc Imaging. 2019;12:784-94.
McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). With the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2022;24:4-131.
Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Colvin MM, et al. 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. J Am Coll Cardiol. 2017;70:776-803.
Curtis JP, Sokol SI, Wang Y, Rathore SS, Ko DT, Jadbabaie F, et al. The association of left ventricular ejection fraction, mortality, and cause of death in stable outpatients with heart failure. J Am Coll Cardiol. 2003;42:736-42.
Vizzardi E, D'Aloia A, Giubbini R, Bordonali T, Bugatti S, Pezzali N, et al. Effect of spironolactone on left ventricular ejection fraction and volumes in patients with class I or II heart failure. Am J Cardiol. 2010;106:1292-6.
Cicoira M, Zanolla L, Rossi A, Golia G, Franceschini L, Brighetti G, et al. Long-term, dose-dependent effects of spironolactone on left ventricular function and exercise tolerance in patients with chronic heart failure. J Am Coll Cardiol. 2002;40:304-10.