BACKGROUND The prognostic value of physical examination, its relation to quality of life, and influence of therapy in heart failure with preserved ejection fraction is not well known. METHODS AND RESULTS We studied participants from the Americas with available physical examination (jugular venous distention, rales, and edema) at baseline in the TOPCAT trial (Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist). The association of the number of signs of congestion with the primary outcome (cardiovascular death or heart failure hospitalization), its individual components, and all-cause mortality was assessed using time-updated, multivariable-adjusted Cox regression analyses. We evaluated whether spironolactone improved congestion at 4 months and whether improvement in congestion was related to quality of life as assessed by Kansas City Cardiomyopathy Questionnaire overall summary scores and to outcomes. Among 1644 participants, 22%, 54%, 20%, and 4% had 0, 1, 2, and 3 signs of congestion, respectively, at baseline. After multivariable adjustment, each additional increase in sign of congestion was associated with a 30% to 60% increased risk of each outcome ( P<0.001). Spironolactone reduced the total number of signs of congestion by -0.10 ( P=0.005) signs, jugular venous distention (odds ratio, 0.60; P=0.01), and edema (odds ratio, 0.74; P=0.006) at 4 months compared with placebo. Each reduction in sign of congestion was independently associated with a 4.0 (95% CI, 2.4-5.6) point improvement in Kansas City Cardiomyopathy Questionnaire overall summary score. When assessed simultaneously, time-updated, but not baseline congestion, predicted outcomes. CONCLUSIONS In heart failure with preserved ejection fraction, the physical exam provides independent prognostic value for adverse outcomes. Spironolactone improved congestion compared with placebo. Reducing congestion was independently associated with improved quality of life and outcomes and is a modifiable risk factor. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov . Unique identifier: NCT00094302.

中文翻译：

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保留射血分数对心力衰竭患者进行心血管体格检查和螺内酯的影响。

背景技术体检的预后价值，其与生活质量的关系以及在射血分数保持不变的情况下对心力衰竭的治疗影响尚不为人所知。方法和结果我们在TOPCAT试验（用醛固酮拮抗剂治疗保留的心脏功能性心力衰竭）的基线研究了来自美洲的参加者，进行了体格检查（颈静脉扩张，罗音和水肿）。使用时间更新的，多变量调整的Cox回归分析评估了充血迹象的数量与主要结局（心血管死亡或心力衰竭住院），其各个组成部分以及全因死亡率之间的关系。我们根据堪萨斯城心肌病问卷调查的总体摘要评分和水平评估了螺内酯是否可改善4个月时的充血以及充血的改善是否与生活质量有关。在1644名参与者中，有22％，54％，20％和4％在基线时分别有0、1、2和3个拥塞迹象。经过多变量调整后，充血迹象的每增加一次，则每种预后的风险增加30％至60％（P <0.001）。与4个月相比，螺内酯将充血迹象总数减少-0.10（P = 0.005）迹象，颈静脉扩张（比值比，0.60； P = 0.01）和水肿（比值比，0.74； P = 0.006）。安慰剂。拥塞迹象的每次减少都独立地与4.0（95％CI，2.4-5）相关。6）堪萨斯城心肌病调查问卷的总体要点得分得到提高。当同时进行评估时，可以更新时间（而不是基线拥堵）的预测结果。结论在保留射血分数的心力衰竭中，体格检查可为不良预后提供独立的预后价值。螺内酯与安慰剂相比可改善充血。减少交通拥塞与改善生活质量和改善结局独立相关，并且是可改变的危险因素。临床试验注册网址：https://www.clinicaltrials.gov。唯一标识符：NCT00094302。身体检查为不良后果提供独立的预后价值。螺内酯与安慰剂相比可改善充血。减少交通拥堵与​​改善生活质量和改善结局独立相关，并且是可改变的危险因素。临床试验注册网址：https://www.clinicaltrials.gov。唯一标识符：NCT00094302。身体检查为不良后果提供独立的预后价值。螺内酯与安慰剂相比可改善充血。减少交通拥堵与​​改善生活质量和改善结局独立相关，并且是可改变的危险因素。临床试验注册网址：https://www.clinicaltrials.gov。唯一标识符：NCT00094302。