![topcat topcat](https://66.media.tumblr.com/8c891646fb12fac89083950ad568ec8f/tumblr_ovvrbbt5ly1w599yeo1_500.jpg)
"Top Cat Tours" is a bus-tour and charter company in Kelowna, BC (Canada).Harvey Birdman, Attorney at Law - "The Death of Harvey Birdman" (2007).
![topcat topcat](https://images-na.ssl-images-amazon.com/images/I/41OTLQenqHL._RI_.jpg)
![topcat topcat](https://sklepsumowy.pl/images/Sygnalizatory_Bran/DAM/TOPCAT/TOPCAT-Zestaw-sygnalizatorów-sumowych-Mad-Cat-aset1.png)
Therefore, the results of the 'Americas' subgroup may be the most accurate reflection of the effect of spironolactone in HFpEF. This indicates that significantly more participants from Russia did not receive the study drug, and raises the potential of misconduct at these study sites. Russia/Georgia: 9.3% vs 8.4%, HR 1.10 (0.79-1.51)Ĭredibility of this subgroup effect has been increased by a substudy demonstrating that participants from Russia were far more likely than those from North America to have no detectable serum concentrations of spironolactone metabolites. Subgroup analysis: Primary outcome varied based on region (Americas vs Russia/Georgia, p<0.001 for interaction)Īmericas: Spironolactone 27.3% vs placebo 31.8%, HR 0.82 (0.69-0.98) (NNT=23) Unclear risk of bias: Loss-to-follow-up on vital status ~4%
#Topcat trial#
Low risk of bias characteristics: Randomized, allocation-concealed, double-blind trial analyzed using intention-to-treat population Heart transplant recipient or currently implanted LVADĬhronic pulmonary disease: Requiring home O2 or PO steroids, hospitalization for exacerbation within 12 months, or significant in the opinion of the investigator Infiltrative or hypertrophic obstructive cardiomyopathy (HoCM) Hemodynamically significant uncorrected primary valvular heart disease Heart failure with preserved ejection fraction (HFpEF):ĭefined as a clinical syndrome of signs & symptoms of HF with normal systolic function (LVEF >50% & LV end-diastolic volume index 45% (measured within 6 months prior to randomization & after any prior ACS)Ĭontrolled SBP (100 pg/mL (or N-terminal pro-BNP >360 pg/mL) within 30 days, not explained by another disease entity The label of "HFpEF" does not yet offer an actionable management plan. In this context, spironolactone remains useful for patients with HFpEF & resistant hypertension.
![topcat topcat](https://windows-cdn.softpedia.com/screenshots/TOPCAT-Full_1.png)
Consistent with other "negative" studies in HFpEF, the results of TOPCAT supports the notion that patients with "HFpEF" should receive symptomatic treatment for HF, & interventions to reduce morbidity & mortality according to the underlying etiology. Spironolactone for heart failure with preserved ejection fraction.