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Weight changes in heart failure with preserved ejection fraction: findings from TOPCAT
Clinical Research in Cardiology ( IF 5 ) Pub Date : 2021-11-10 , DOI: 10.1007/s00392-021-01962-4
João Pedro Ferreira 1, 2 , Patrick Rossignol 1 , Brian L Claggett 3 , Scott D Solomon 3 , Bertram Pitt 4 , Marc Pfeffer 3 , Faiez Zannad 1
Affiliation  

Background

Weight loss has been associated with poor outcomes in patients with heart failure (HF). However, few data are available for patients with heart failure with preserved ejection fraction (HFpEF). The impact of weight gain on outcomes has not been frequently reported either.

Aims

To study post-randomization weight changes and how these could impact outcomes and the effect of spironolactone in patients with HFpEF enrolled in the TOPCAT-Americas trial (N = 1767).

Methods

Mixed-effects regressions and time-updated Cox models to assess the factors associated with weight changes and their impact on subsequent outcomes.

Results

Over a median follow-up of 3 years, 824 (47%) patients experienced weight loss ≥ 5% and 390 (22%) experienced weight loss ≥ 10%. Patients experiencing weight loss were older and more frequently women with severe HF symptoms. Spironolactone slightly reduced body weight before 12 months of follow-up: β = − 0.55 (− 0.82 to − 0.29) kg, without effect on weight afterwards: β = 0.01 (− 0.66 to 0.68) kg; treatment-by-time interaction P = 0.0015. Spironolactone did not increase the odds of weight loss but reduced the odds of weight gain. Weight loss ≥ 5% was associated with a higher risk of cardiovascular and all-cause death irrespective of baseline body mass index: HR = 1.47, 95%CI = 1.07–2.01 and HR = 1.84, 95%CI = 1.46–2.31, respectively. Weight gain was not associated with an increased risk of any outcome.

Conclusion

Weight loss ≥ 5% was frequent and independently associated with an increased risk of subsequent mortality. Spironolactone induced only slight body weight reductions early after its introduction and up to a maximum of 8–12 months of follow-up.

Graphical abstract

Association between body weight changes and subsequent death. Legend: HR, hazard ratio from time-updated Cox models. Model adjusted on age, sex, race, NYHA class, systolic blood pressure, diabetes, atrial fibrillation, previous myocardial infarction, previous heart failure hospitalization, estimated glomerular filtration rate, diuretic use, and baseline weight.



中文翻译:

保留射血分数的心力衰竭的体重变化:来自 TOPCAT 的研究结果

背景

体重减轻与心力衰竭 (HF) 患者的不良预后有关。然而,很少有数据可用于射血分数保留的心力衰竭(HFpEF)患者。体重增加对结果的影响也没有经常报道。

目标

研究随机分组后体重变化以及这些变化如何影响结局以及螺内酯对 TOPCAT-Americas 试验 ( N  = 1767) 的 HFpEF 患者的影响。

方法

混合效应回归和时间更新的 Cox 模型,以评估与体重变化相关的因素及其对后续结果的影响。

结果

在 3 年的中位随访期间,824 名 (47%) 患者体重减轻 ≥ 5%,390 名 (22%) 患者体重减轻 ≥ 10%。经历体重减轻的患者年龄较大,且出现严重心衰症状的女性较多。在 12 个月的随访前,螺内酯略微减轻体重:β = - 0.55(- 0.82 至 - 0.29)kg,之后对体重无影响:β = 0.01(- 0.66 至 0.68)kg;治疗时间相互作用P  = 0.0015。螺内酯没有增加体重减轻的几率,但降低了体重增加的几率。无论基线体重指数如何,体重减轻 ≥ 5% 与心血管和全因死亡风险较高相关:HR = 1.47, 95%CI = 1.07–2.01 和 HR = 1.84, 95%CI = 1.46–2.31 . 体重增加与任何结果的风险增加无关。

结论

体重减轻 ≥ 5% 很常见,并且与随后的死亡风险增加独立相关。螺内酯在引入后早期仅引起轻微的体重减轻,最长可达 8-12 个月的随访。

图形概要

体重变化与随后的死亡之间的关联。图例:HR,来自时间更新的 Cox 模型的风险比。模型根据年龄、性别、种族、NYHA 分级、收缩压、糖尿病、心房颤动、既往心肌梗死、既往心力衰竭住院史、估计肾小球滤过率、利尿剂使用和基线体重进行了调整。

更新日期:2021-11-10
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