[Spironolactone not effective in diastolic heart failure]

The treatment of chronic systolic heart failure has shown important improvements, but there are no evidence-based medical treatment options for patients with diastolic heart failure. A recent elaborate study, the TOPCAT trial, failed to show a beneficial effect of spironolactone on the primary composite endpoint of cardiovascular death or hospital admission for heart failure in patients with heart failure and preserved ejection fraction (HFpEF). After ACE inhibitors and angiotensin receptor blockers, this is the third group of medications that previously showed a beneficial effect in patients with heart failure and a reduced ejection fraction (HFrEF), but failed in HFpEF patients. The difficulties in the study design and in interpreting the results of the TOPCAT study may contribute to this negative conclusion. However, a better understanding of the pathophysiology of HFpEF is needed to find strategies that improve the clinical outcome in patients with diastolic heart failure.