Lessons Learned from the TOPCAT Trial

Approximately half of patients with heart failure have a preserved left ventricular ejection fraction. In sharp contrast to treatment of heart failure with reduced leftventricular ejection fraction, evidence-based drug therapies for treatment of heart failure with preserved left ventricular ejection fraction are still lacking. 

The 3 major outcome trials performed in patients with heart failure and preserved left ventricular ejection fraction using inhibitors of the renin-angiotensin-aldosterone system did not meet their primary endpoints. The Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist (TOPCAT) trial was a randomized, double-blind, placebo-controlled trial which randomized 3,445 patients with symptomatic heart failure and a left ventricular ejection fraction of 45% or more to receive either spironolactone 15 mg to 45 mg daily or placebo. Of these patients, 1,767 patients were enrolled from the United States, Canada, Brazil, and Argentina, and 1,678 patients were enrolled from Russia and Georgia.  Read more>>>>>>>>>>>>>>>>