bashalo.blogg.se - Topcat trial

TOPCAT TRIAL TRIAL
TOPCAT TRIAL PLUS

The majority of these patients were already on an ACEI/ARB.

TOPCAT TRIAL TRIAL

The results of the TOPCAT trial indicate that spironolactone is not superior to placebo in improving CV outcomes in patients with HFpEF. Benefit of spironolactone compared with placebo was similar to the overall population (p for interaction = 0.38). These patients had the worst prognosis among the patients enrolled (HR 2.10, 95% CI 1.26-3.5, p = 0.004). HFpEF phenotype suggestive of amyloid: Among 590 patients with detailed echocardiography data, 23% had echo phenotype suggestive of amyloid (septal thickness ≥1.2 cm, s’ velocity ≤6 cm/s). placebo based on gender: women, 25.1% vs. Women were older with fewer comorbidities. There was no effect modification by AF for the primary endpoint for spironolactone vs. Post-randomization AF occurred in 6.3% of patients and was associated with an increased early risk of the primary outcome (HR 2.32, 95% CI 1.59-3.40, p < 0.0001). Patients with any history/prevalent AF had numerically higher incidence of the primary endpoint (12.1% vs. These patients had higher left atrial volumes than patients without AF. Influence of AF: AF was common, either based on ECG at enrollment (25%) or based on history (18%). 9.1%, p 2 upper limit of normal were both significantly higher in the spironolactone arm. CHF hospitalizations were lower (12.0% vs. 5 events, p = 0.48) were similar between the two arms. p = 0.35) and aborted cardiac arrest (3 vs. Individual components including CV mortality (9.3% vs. The primary endpoint of CV death, chronic HF (CHF) hospitalization, or resuscitated cardiac arrest over 6 years was similar between the spironolactone and placebo arms (18.6% vs. Close to 29% of patients were enrolled into stratum II (elevated B-type natriuretic peptide /N-terminal proBNP). Coexisting coronary artery disease was noted in 59% and atrial fibrillation (AF) in 35%. Hypertension was present in 92% of patients, with median blood pressure (BP) of 130/80 mm Hg. The baseline EF was 56%, 52% were female, and nearly two-thirds of the patients had New York Heart Association (NYHA) class II symptoms.

Baseline characteristics were fairly similar between the two arms. Concomitant Medications:Īngiotensin-converting enzyme inhibitor (ACEI)/angiotensin-receptor blocker (ARB) (84%), diuretic (82%), and statin (53%)Ī total of 3,445 patients were randomized at 233 sites in six countries: 1,722 to spironolactone and to 1,723 to placebo. Spironolactone was initiated at a dose of 15 mg/day and uptitrated to a maximum of 45 mg daily during the first 4 months of randomization. Patients were randomized in 1:1 fashion to either spironolactone versus placebo.

Individual components of the composite outcome.

Composite of CV mortality, aborted cardiac arrest, or hospitalization for the management of HF.

Restrictive, infiltrative, or hypertrophic cardiomyopathy.

Controlled systolic BP, defined as a target systolic BP 2.5 mg/dl.

Left ventricular EF (LVEF) ≥45%, assessed within 6 months.

Until today, it remains controversial what caused it. However, the advanced civilisation of this city, which was inhabited for almost 1000 years, came to an abrupt end. Liangzhu was declared a UNESCO World Heritage Site in 2019. Thousands of elaborately crafted jade burial objects were found during excavations. Metals, however, were still unknown in this culture. In the history of human civilisation, this is one of the first examples of highly developed communities based on a water infrastructure. The very humid climatic conditions continued intermittently for another 300 years, as the geologists show from the cave data. Read more: A 1988 warning about climate change was mostly right "The massive monsoon rains probably led to such severe flooding of the Yangtze and its branches that even the sophisticated dams and canals could no longer withstand these masses of water, destroying Liangzhu City and forcing people to flee." "This is amazingly precise," says the geologist.

TOPCAT TRIAL PLUS

The precise dating was done by uranium-thorium analyses at Xi'an Jiaotong University, whose measurement accuracy is plus or minus 30 years. Evidence for this was provided by the isotope records of carbon, which were measured at the University of Innsbruck.