Spironolactone: TOPCAT or underdog?

0:00-0:40: Intro
0:41-1:22: Introduction of Dr. Kathleen Faulkenberg
1:23-5:45: Overview of TOPCAT
5:46-8:28: Kathleen’s Overall Thoughts 
8:29-10:11: TOPCAT Controversy
10:12-11:15: Spironolactone Metabolite Differences Between Regions
11:16-11:59: More Questions Around TOPCAT
12:00-12:51: What do we do with results from TOPCAT?
12:52-15:19: Final Thoughts
15:20-16:01: Closing


  • TOPCAT: Pitt B, Pfeffer MA, Assmann SF, et al. Spironolactone for Heart Failure with Preserved Ejection Fraction. N Engl J Med 2014;370:1383-92.
  • de Denus S, Desai AS, Leclair G, et al. Spironolactone Metabolites in TOPCAT – New Insights into Regional Variation. N Engl J Med 2017;376:1690-1692.
  • Pfeffer MA, Claggett B, Assmann SF, et al. Regional variation in patients and outcomes in the Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist (TOPCAT) trial. Circulation 2015;131(1):34-42.
  • Cohen JB, Schrauben SJ, Zhao L, et al. Clinical Phenogroups in Heart Failure With Preserved Ejection Fraction: Detailed Phenotypes, Prognosis, and Response to Spironolactone. JACC Heart Fail 2020; DOI: 10.1016/j.jchf.2019.09.009.

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