Defining Diastolic Heart Failure and Identifying Effective Therapies

摘要

IN THIS ISSUE OF JAMA, EDELMANN AND COLLEAGUES1 RE-port the results of the first substantial randomized, placebo-controlled study investigating the effects of a min-eralocorticoid antagonist (MRA), spironolactone, on cardiac function and exercise capacity in patients diagnosed as having heart failure with preserved ejection fraction (HFpEF). The Aldo-DHF trial included 422 patients (mean age, 67 years; 52% women) with chronic, stable symptoms attributed to heart failure, a left ventricular ejection fraction (LVEF) of at least 50%, echocardiographic evidence of LV diastolic dysfunction or atrial fibrillation, and a peak exercise oxygen consumption of 25 mL/kg/min or less during bicycle exercise. Most patients were receiving treatment for hypertension, including thiazide diuretics.