Table 4. Studies of the impact of aldosterone antagonist therapy on cardiac structure and function in HFpEF.

Author (year)	N	Intervention	Inclusion	Age (yr)	Female	F/u (mo)	Endpoints
Daniel et al 2009¹²	11	Spironolactone 25 mg/day ^*no placebo arm	Prior HF hosp LVEF >50%	72±8	100%	4	↓ E/e′ No change in E/A ratio, e′, LV dimension or WT
Mak et al 2009¹³	44	Epleronone 25-50 mg/daily	Prior HF hosp BNP>100 LVEF >45 % DDfxn on echo	80±7.8	54%	12	↓DT No change in E/A ratio, e′, E/e′, LAVi, LVMi
Deswal et al 2011¹⁴	44	Epleronone 25-50 mg/daily	NYHA Class II/III LVEF >50% BNP>100	70±9	7%	6	↓E/e′ No change in E/A ratio, e′, LAV, LV dimension, LVMi
Kurrelmeyer et al 2014¹⁵	48	Spironolactone 25 mg/day	NYHA Class II/III LVEF >50% BNP>62 DDfxn on echo	71±2	100%	6	↓E/e′, ↓e′, ↓LV mass No change in E/A ratio, LAV, LV dimension
ALDO-DHF 2013¹⁶	422	Spironolactone 25 mg/day	≥50 years old NYHA II/III LVEF ≥50% DDfxn on echo Peak VO2 ≤25	67±8	52%	12	↓E/e′, ↓e′, ↓LVMi, ↓LV dimension, ↑LVEF No change in E/A ratio, LAV
TOPCAT Echo	239	Spironolactone 15-45 mg/day	≥50 years old NYHA II/III LVEF ≥45% Prior HF hosp or elevated natriuretic peptide level	70±9	52%	23±12	No change in echocardiographic measures^*

Among patients enrolled in the Americas only, spironolactone was associated with modest decrease in LVESV, decrease in E/A ratio, and increase in LVEF (Supplemental Table 8); DT – E wave deceleration time, WT – wall thickness.