Incident Hyperkalemia, Hypokalemia, and Clinical Outcomes During Spironolactone Treatment of Heart Failure With Preserved Ejection Fraction: Analysis of the TOPCAT Trial.

Abstract:

BACKGROUND:In patients with heart failure and preserved ejection fraction (HF-PEF) randomized in the Americas as part of the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial, treatment with spironolactone enhanced the risk of hyperkalemia but reduced the risk of hypokalemia. We examined the clinical correlates and prognostic implications of incident hypo- and hyperkalemia during study follow-up. METHODS:We defined the region-specific incidence of hypokalemia (potassium [K+] <3.5 mmol/l) and hyperkalemia (K+ ≥5.5 mmol/l) among both placebo- and spironolactone-assigned patients in TOPCAT. Factors associated with incident hypokalemia and hyperkalemia and the relationship between incident K+ abnormalities and the risk of subsequent mortality were analyzed in multivariable regression models restricted to the Americas. RESULTS:In the Americas, assignment to spironolactone increased risk for hyperkalemia (hazard ratio 3.21, 95% confidence interval 2.46-4.20, P < .001) and reduced risk of hypokalemia (hazard ratio 0.43, 95% confidence interval 0.34-0.55, P < .001). Assignment to spironolactone, lower estimated glomerular filtration rate, higher baseline K+, diabetes, and lower hemoglobin were associated with incident hyperkalemia, whereas assignment to placebo, lower K+, younger age, lower estimated glomerular filtration rate, and use of diuretics at baseline were associated with hypokalemia. The combination of spironolactone and an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker was associated with incremental risk for hyperkalemia and protection from hypokalemia. Independent of region, both hypokalemia and hyperkalemia, were associated with higher risk for cardiovascular and all-cause mortality in multivariable-adjusted Cox regression models. CONCLUSIONS:Both hyperkalemia and hypokalemia are associated with heightened risk for mortality in HF-PEF. Use of spironolactone in this population requires careful laboratory surveillance of K+ and creatinine, particularly in high-risk groups.

journal_name

J Card Fail

authors

Desai AS,Liu J,Pfeffer MA,Claggett B,Fleg J,Lewis EF,McKinlay S,O'Meara E,Shah SJ,Sweitzer NK,Solomon S,Pitt B

doi

10.1016/j.cardfail.2018.03.002

subject

Has Abstract

pub_date

2018-05-01 00:00:00

pages

313-320

issue

5

eissn

1071-9164

issn

1532-8414

pii

S1071-9164(18)30099-X

journal_volume

24

pub_type

杂志文章,多中心研究,随机对照试验
  • Temporal Differences in Outcomes During Long-Term Mechanical Circulatory Support.

    abstract:BACKGROUND:Device indications have changed for placement of continuous-flow left ventricular assist devices (CF-LVADs). We performed a multicenter analysis evaluating temporal variations in outcomes after CF-LVAD implantation. METHODS & RESULTS:We retrospectively defined 3 time intervals to reflect changes in CF-LVAD ...

    journal_title:Journal of cardiac failure

    pub_type: 杂志文章,多中心研究

    doi:10.1016/j.cardfail.2017.07.403

    authors: Maltais S,Anwer LA,Haglund NA,Cowger J,Shah P,Aaronson KD,Pagani FD,Dunlay SM,Singh R,Salerno CT,Stulak JM

    更新日期:2017-12-01 00:00:00

  • Results of the Prospective Minnesota Study of ECHO/TDI in Cardiac Resynchronization Therapy (PROMISE-CRT) study.

    abstract:BACKGROUND:Retrospective single-center studies have shown that measures of mechanical dyssynchrony before cardiac resynchronization therapy (CRT), or acute changes after CRT, predict response better than QRS duration. The Prospective Minnesota Study of Echocardiographic/TDI in Cardiac Resynchronization Therapy (PROMISE...

    journal_title:Journal of cardiac failure

    pub_type: 杂志文章,多中心研究,随机对照试验

    doi:10.1016/j.cardfail.2008.12.009

    authors: Bank AJ,Kaufman CL,Kelly AS,Burns KV,Adler SW,Rector TS,Goldsmith SR,Olivari MT,Tang C,Nelson L,Metzig A,PROMISE-CRT Investigators.

    更新日期:2009-06-01 00:00:00

  • Airway resistance in chronic heart failure measured by impulse oscillometry.

    abstract:BACKGROUND:Patients with chronic heart failure (CHF) complain of breathlessness and fatigue on exertion, have reduced peak oxygen consumption (pV(O(2))), and an increased ventilatory response to exercise (V(E)/V(CO(2)) slope). These limitations correlate with abnormalities of spirometry (forced expiratory volume in 1 s...

    journal_title:Journal of cardiac failure

    pub_type: 杂志文章

    doi:10.1054/jcaf.2002.126916

    authors: Witte KK,Morice A,Clark AL,Cleland JG

    更新日期:2002-08-01 00:00:00

  • Relationship between anemia and health care costs in heart failure.

    abstract:BACKGROUND:Anemia is associated with higher morbidity and mortality in patients with heart failure (HF), but its implications for heath care costs are not well described. METHODS AND RESULTS:We analyzed data on 1056 patients with symptomatic HF seen at Duke University between 2002 and 2006. Health care costs were obta...

    journal_title:Journal of cardiac failure

    pub_type: 杂志文章

    doi:10.1016/j.cardfail.2009.06.435

    authors: Allen LA,Anstrom KJ,Horton JR,Shaw LK,Eisenstein EL,Felker GM

    更新日期:2009-12-01 00:00:00

  • Intravenous salt supplementation with low-dose furosemide for treatment of acute decompensated heart failure.

    abstract:BACKGROUND:Theoretically, salt supplementation should promote diuresis through increasing the glomerular filtration rate (GFR) during treatment of acute decompensated heart failure (ADHF) even with low-dose furosemide; however, there is little evidence to support this idea. METHODS AND RESULTS:This was a prospective, ...

    journal_title:Journal of cardiac failure

    pub_type: 杂志文章,随机对照试验

    doi:10.1016/j.cardfail.2014.01.012

    authors: Okuhara Y,Hirotani S,Naito Y,Nakabo A,Iwasaku T,Eguchi A,Morisawa D,Ando T,Sawada H,Manabe E,Masuyama T

    更新日期:2014-05-01 00:00:00

  • How does cardiac resynchronization therapy improve exercise capacity in chronic heart failure?

    abstract:BACKGROUND:Studies have shown that neither ejection fraction nor hemodynamic abnormalities during exercise in chronic heart failure (HF) correlate with symptoms of fatigue and exhaustion. The concept that exercise limitation in patients with chronic HF is due to abnormal hemodynamics during exercise has been revised to...

    journal_title:Journal of cardiac failure

    pub_type: 杂志文章,评审

    doi:10.1016/j.cardfail.2005.03.002

    authors: Middlekauff HR

    更新日期:2005-09-01 00:00:00

  • Rationale and design of the enoximone clinical trials program.

    abstract:BACKGROUND:Chronic heart failure is a disease syndrome characterized in its advanced stages by a poor quality of life, frequent hospitalizations, and a high risk of mortality. In advanced and ultra-advanced chronic heart failure, many treatment options, such as cardiac transplantation and mechanical devices, are severe...

    journal_title:Journal of cardiac failure

    pub_type: 杂志文章

    doi:10.1016/j.cardfail.2005.10.013

    authors: Lowes BD,Shakar SF,Metra M,Feldman AM,Eichhorn E,Freytag JW,Gerber MJ,Liard JF,Hartman C,Gorczynski R,Evans G,Linseman JV,Stewart J,Robertson AD,Roecker EB,Demets DL,Bristow MR

    更新日期:2005-12-01 00:00:00

  • Pioglitazone and heart failure: results from a controlled study in patients with type 2 diabetes mellitus and systolic dysfunction.

    abstract:BACKGROUND:Thiazolidinediones are associated with fluid retention, often interpreted as worsening cardiac function, limiting their use in patients with heart failure (HF). We compared the effects of pioglitazone and glyburide on cardiac function in patients with type 2 diabetes, systolic dysfunction, and New York Heart...

    journal_title:Journal of cardiac failure

    pub_type: 杂志文章,多中心研究,随机对照试验

    doi:10.1016/j.cardfail.2008.02.007

    authors: Giles TD,Miller AB,Elkayam U,Bhattacharya M,Perez A

    更新日期:2008-08-01 00:00:00

  • Prognosis of hospitalized new-onset systolic heart failure in Indo-Asians--a lethal problem.

    abstract:BACKGROUND:Systolic heart failure (SHF), particularly when requiring hospital admission carries a poor prognosis. There is a paucity of data in Indo-Asians on outcomes of SHF, among whom the burden of cardiovascular disease is consistently rising. The purpose of this study was to determine the frequency and predictors ...

    journal_title:Journal of cardiac failure

    pub_type: 杂志文章

    doi:10.1016/j.cardfail.2007.07.005

    authors: Jafary FH,Kumar M,Chandna IE

    更新日期:2007-12-01 00:00:00

  • The dog model of left ventricular remodeling after myocardial infarction.

    abstract:BACKGROUND:For over a century, the dog model has been used widely in research studying cardiovascular physiology pertinent to humans. It has been specially applied, over the past 2 decades, in research on the pathophysiology and treatment of left ventricular (LV) remodeling and heart failure. METHODS AND RESULTS:Becau...

    journal_title:Journal of cardiac failure

    pub_type: 杂志文章,评审

    doi:10.1054/jcaf.2002.129274

    authors: Jugdutt BI

    更新日期:2002-12-01 00:00:00

  • Metoprolol in dilated cardiomyopathy: is it possible to identify factors predictive of improvement? The Heart Muscle Disease Study Group.

    abstract:BACKGROUND:Some controlled clinical trials showed a beneficial effect of beta-blockers on symptoms, exercise tolerance, and left ventricular function in dilated cardiomyopathy. The purpose of this study was to investigate if there are clinical variables at baseline that could predict a favorable response to long-term m...

    journal_title:Journal of cardiac failure

    pub_type: 杂志文章

    doi:10.1016/s1071-9164(96)80027-3

    authors: DiLenarda A,Gregori D,Sinagra G,Lardieri G,Perkan A,Pinamonti B,Salvatore L,Secoli G,Zecchin M,Camerini F

    更新日期:1996-06-01 00:00:00

  • Joint Commission requirements for discharge instructions in patients with heart failure: is understanding important for preventing readmissions?

    abstract:BACKGROUND:Many approaches have been considered to reduce heart failure (HF) readmissions. The Joint Commission on Accreditation of Health Care Organizations (JC) requires hospitals to provide patients admitted for HF with discharge instructions that address 6 topics related to HF management: diet, exercise, weight mon...

    journal_title:Journal of cardiac failure

    pub_type: 杂志文章

    doi:10.1016/j.cardfail.2014.06.358

    authors: Regalbuto R,Maurer MS,Chapel D,Mendez J,Shaffer JA

    更新日期:2014-09-01 00:00:00

  • Racial differences in response to therapy for heart failure: analysis of the vasodilator-heart failure trials. Vasodilator-Heart Failure Trial Study Group.

    abstract:BACKGROUND:Heart failure in blacks has been associated with a poorer prognosis than in whites. In such diseases as hypertension, blacks show pathophysiological differences and respond differently to some therapies than whites. The aim of this study is to evaluate the clinical characteristics and response to therapy of ...

    journal_title:Journal of cardiac failure

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1016/s1071-9164(99)90001-5

    authors: Carson P,Ziesche S,Johnson G,Cohn JN

    更新日期:1999-09-01 00:00:00

  • Genetic testing for dilated cardiomyopathy in clinical practice.

    abstract:BACKGROUND:Familial involvement is common in dilated cardiomyopathy (DCM) and >40 genes have been implicated in causing disease. However, the role of genetic testing in clinical practice is not well defined. We examined the experience of clinical genetic testing in a diverse DCM population to characterize the prevalenc...

    journal_title:Journal of cardiac failure

    pub_type: 杂志文章

    doi:10.1016/j.cardfail.2012.01.013

    authors: Lakdawala NK,Funke BH,Baxter S,Cirino AL,Roberts AE,Judge DP,Johnson N,Mendelsohn NJ,Morel C,Care M,Chung WK,Jones C,Psychogios A,Duffy E,Rehm HL,White E,Seidman JG,Seidman CE,Ho CY

    更新日期:2012-04-01 00:00:00

  • Quality of life assessment for acute heart failure patients from emergency department presentation through 30 days after discharge: a pilot study with the Kansas City Cardiomyopathy Questionnaire.

    abstract:BACKGROUND:There are no well validated patient-reported disease status instruments for acute heart failure (HF). We assessed the feasibility of using the Kansas City Cardiomyopathy Questionnaire (KCCQ) during acute heart failure hospitalization, and the association of acute changes with 30-day readmission. METHODS AND...

    journal_title:Journal of cardiac failure

    pub_type: 杂志文章

    doi:10.1016/j.cardfail.2013.11.010

    authors: Sauser K,Spertus JA,Pierchala L,Davis E,Pang PS

    更新日期:2014-01-01 00:00:00

  • Cardiorenal interactions in acute decompensated heart failure: contemporary concepts facing emerging controversies.

    abstract::Simultaneous dysfunction of the heart and the kidney represents a distinct spectrum of disease states composed of complex clinical scenarios with adverse outcomes. Worsening renal function (WRF) in the setting of acute decompensated heart failure (ADHF) is one such clinical setup for which the underlying mechanisms ar...

    journal_title:Journal of cardiac failure

    pub_type: 杂志文章,评审

    doi:10.1016/j.cardfail.2014.09.005

    authors: Kazory A,Elkayam U

    更新日期:2014-12-01 00:00:00

  • Angiotensin receptor neprilysin inhibition in heart failure: mechanistic action and clinical impact.

    abstract::Heart failure (HF) is an increasingly common syndrome associated with high mortality and economic burden, and there has been a paucity over the past decade of new pharmacotherapies that improve outcomes. However, recent data from a large randomized controlled trial compared the novel agent LCZ696, a dual-acting angiot...

    journal_title:Journal of cardiac failure

    pub_type: 杂志文章,评审

    doi:10.1016/j.cardfail.2015.07.008

    authors: Buggey J,Mentz RJ,DeVore AD,Velazquez EJ

    更新日期:2015-09-01 00:00:00

  • Autoantibodies Specifically Against β1 Adrenergic Receptors and Adverse Clinical Outcome in Patients With Chronic Systolic Heart Failure in the β-Blocker Era: The Importance of Immunoglobulin G3 Subclass.

    abstract:OBJECTIVE:To elucidate the prevalence and role of β1 adrenergic receptor autoantibodies (β1AR-AAb) belonging to the immunoglobulin (Ig)G3 subclass in patients with heart failure (HF) treated with β-adrenergic blockers. BACKGROUND:Several cardiac AAbs have been reported to be present in sera from patients with dilated ...

    journal_title:Journal of cardiac failure

    pub_type: 杂志文章

    doi:10.1016/j.cardfail.2016.03.005

    authors: Nagatomo Y,Li D,Kirsop J,Borowski A,Thakur A,Tang WH

    更新日期:2016-06-01 00:00:00

  • Extending the boundaries of cardiac resynchronization therapy: efficacy in atrial fibrillation, New York heart association class II, and narrow QRS heart failure patients.

    abstract:BACKGROUND:Large-scale clinical trials have demonstrated the benefits of cardiac resynchronization therapy (CRT) in patients with New York Heart Association (NYHA) Class III/IV heart failure, systolic left ventricular dysfunction, and a wide QRS. However, additional patient groups may also benefit from CRT. METHODS AN...

    journal_title:Journal of cardiac failure

    pub_type: 杂志文章,meta分析

    doi:10.1016/j.cardfail.2009.12.018

    authors: Wein S,Voskoboinik A,Wein L,Billah B,Krum H

    更新日期:2010-05-01 00:00:00

  • Effects of lisinopril in patients with heart failure and chronic atrial fibrillation.

    abstract::Although atrial fibrillation is common in patients with heart failure, patients with atrial fibrillation are often excluded from congestive heart failure trials or are not analyzed separately. Consequently, while the effect of angiotensin-converting enzyme inhibitors in patients with sinus rhythm is well established, ...

    journal_title:Journal of cardiac failure

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1016/s1071-9164(05)80004-1

    authors: Van Den Berg MP,Crijns HJ,Van Veldhuisen DJ,Griep N,De Kam PJ,Lie KI

    更新日期:1995-12-01 00:00:00

  • Variability in the clinical status of patients with advanced heart failure.

    abstract:BACKGROUND:The importance of repeated clinical assessments of patients with heart failure is widely accepted. The frequency of such follow-up is not established and is likely to depend on the natural history and variability of patients' health status and the availability and use of appropriate treatments. METHODS AND ...

    journal_title:Journal of cardiac failure

    pub_type: 杂志文章,多中心研究

    doi:10.1016/j.cardfail.2003.12.008

    authors: Hauptman PJ,Masoudi FA,Weintraub WS,Pina I,Jones PG,Spertus JA,Cardiovascular Outcomes Research Consortium.

    更新日期:2004-10-01 00:00:00

  • Improvement of serum NT-ProBNP predicts improvement in cardiac function and favorable prognosis after cardiac resynchronization therapy for heart failure.

    abstract:BACKGROUND:Cardiac resynchronization therapy (CRT) is now an established therapy for patients with advanced heart failure with electromechanical delay, although nonresponders have been observed. Because natriuretic peptides are relevant markers to reflect the severity of heart failure and filling pressure of cardiac ch...

    journal_title:Journal of cardiac failure

    pub_type: 杂志文章

    doi:10.1016/j.cardfail.2005.04.007

    authors: Yu CM,Fung JW,Zhang Q,Chan CK,Chan I,Chan YS,Kong SL,Sanderson JE,Lam CW

    更新日期:2005-06-01 00:00:00

  • Cardiac Adenylyl Cyclase and Phosphodiesterase Expression Profiles Vary by Age, Disease, and Chronic Phosphodiesterase Inhibitor Treatment.

    abstract:BACKGROUND:Pediatric heart failure (HF) patients have a suboptimal response to traditional HF medications, although phosphodiesterase-3 inhibition (PDE3i) has been used with greater success than in the adult HF population. We hypothesized that molecular alterations specific to children with HF and HF etiology may affec...

    journal_title:Journal of cardiac failure

    pub_type: 杂志文章

    doi:10.1016/j.cardfail.2016.07.429

    authors: Nakano SJ,Sucharov J,van Dusen R,Cecil M,Nunley K,Wickers S,Karimpur-Fard A,Stauffer BL,Miyamoto SD,Sucharov CC

    更新日期:2017-01-01 00:00:00

  • The association between high-dose diuretics and clinical stability in ambulatory chronic heart failure patients.

    abstract:OBJECTIVE:In chronic heart failure (HF), diuretic doses increase as the disease progresses, often after hospitalization for instability, and have been associated with worsening renal function and increased mortality. METHODS AND RESULTS:A prospective observational analysis of 183 patients in an advanced HF clinic stra...

    journal_title:Journal of cardiac failure

    pub_type: 杂志文章

    doi:10.1016/j.cardfail.2008.01.015

    authors: Mielniczuk LM,Tsang SW,Desai AS,Nohria A,Lewis EF,Fang JC,Baughman KL,Stevenson LW,Givertz MM

    更新日期:2008-06-01 00:00:00

  • Prospective evaluation of beta-blocker use at the time of hospital discharge as a heart failure performance measure: results from OPTIMIZE-HF.

    abstract:BACKGROUND:The objective of this study was to prospectively evaluate beta-blocker use at hospital discharge as an indicator of quality of care and outcomes in patients with heart failure (HF). METHODS AND RESULTS:Data from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failu...

    journal_title:Journal of cardiac failure

    pub_type: 杂志文章

    doi:10.1016/j.cardfail.2007.06.727

    authors: Fonarow GC,Abraham WT,Albert NM,Stough WG,Gheorghiade M,Greenberg BH,O'Connor CM,Sun JL,Yancy CW,Young JB,OPTIMIZE-HF Investigators and Coordinators.

    更新日期:2007-11-01 00:00:00

  • Teneligliptin Prevents Cardiomyocyte Hypertrophy, Fibrosis, and Development of Hypertensive Heart Failure in Dahl Salt-Sensitive Rats.

    abstract:BACKGROUND:We investigated the effects of the dipeptidyl peptidase 4 inhibitor teneligliptin on cardiac function and hemodynamics during heart failure in hypertensive model rats. METHODS AND RESULTS:Fifty-five male Dahl salt-sensitive rats were divided into 4 groups: control group (0.3% NaCl chow; n = 13), hypertensio...

    journal_title:Journal of cardiac failure

    pub_type: 杂志文章

    doi:10.1016/j.cardfail.2017.09.001

    authors: Yamamoto M,Ishizu T,Seo Y,Suto Y,Sai S,Xu D,Murakoshi N,Kimura T,Kawakami Y,Aonuma K

    更新日期:2018-01-01 00:00:00

  • Searching for evidence: Refractory questions in advanced heart failure.

    abstract:BACKGROUND:Despite ample data from randomized clinical trials (RCTs), the management of advanced heart failure (HF) varies greatly. We examined the most common refractory questions arising in routine inpatient management of advanced HF. METHODS:From the inpatient HF service at 1 hospital, we prospectively recorded cli...

    journal_title:Journal of cardiac failure

    pub_type: 杂志文章

    doi:10.1016/j.cardfail.2003.10.006

    authors: Shah MR,Stevenson LW

    更新日期:2004-06-01 00:00:00

  • Dual Vasopressin V1a/V2 Antagonism: The Next Step in Neurohormonal Modulation in Patients With Heart Failure?

    abstract::Stimulation of the V1a receptor for arginine vasopressin produces myocardial and vascular effects similar to those of angiotensin II while stimulation of the V2 receptor causes fluid retention. There are no data with sustained blockade of the V1a receptor while single-dose experiments suggest benefit. Acute and chroni...

    journal_title:Journal of cardiac failure

    pub_type: 杂志文章,评审

    doi:10.1016/j.cardfail.2017.12.011

    authors: Goldsmith SR,Udelson JE,Gheorghiade M

    更新日期:2018-02-01 00:00:00

  • Heart Failure With Midrange Ejection Fraction in Patients Admitted for Acute Decompensation: A Report from the Japanese Multicenter Registry.

    abstract:BACKGROUND:Patients having heart failure with midrange ejection fraction (HFmrEF: 40% ≤ EF < 50%) are increasingly being considered a new subset of the population with heart failure. Despite recent advances in heart-failure treatment strategies, the prognosis of these patients has not improved substantially over time. ...

    journal_title:Journal of cardiac failure

    pub_type: 杂志文章,多中心研究

    doi:10.1016/j.cardfail.2019.05.010

    authors: Takei M,Kohsaka S,Shiraishi Y,Goda A,Nagatomo Y,Mizuno A,Suzino Y,Kohno T,Fukuda K,Yoshikawa T

    更新日期:2019-08-01 00:00:00

  • Electroanatomic Properties of the Myocardium Predict Response to CD34+ Cell Therapy in Patients With Ischemic and Nonischemic Heart Failure.

    abstract:BACKGROUND:We investigated a correlation between electromechanical properties of the myocardium and response to CD34+ cell therapy in patients with chronic heart failure. METHODS AND RESULTS:We enrolled 40 patients with ischemic cardiomyopathy (ICM) and 40 with nonischemic dilated cardiomyopathy (DCM). All patients we...

    journal_title:Journal of cardiac failure

    pub_type: 杂志文章

    doi:10.1016/j.cardfail.2016.08.002

    authors: Zemljic G,Poglajen G,Sever M,Cukjati M,Frljak S,Androcec V,Cernelc P,Haddad F,Vrtovec B

    更新日期:2017-02-01 00:00:00