{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T05:04:37Z","timestamp":1777352677745,"version":"3.51.4"},"reference-count":46,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2022,1,27]],"date-time":"2022-01-27T00:00:00Z","timestamp":1643241600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100001047","name":"Ian Potter Foundation","doi-asserted-by":"publisher","award":["20162130"],"award-info":[{"award-number":["20162130"]}],"id":[{"id":"10.13039\/501100001047","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["Partnership Grant (1149692)"],"award-info":[{"award-number":["Partnership Grant (1149692)"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["European J of Heart Fail"],"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Subclinical left ventricular dysfunction (LVD) is a prelude to symptomatic heart failure (HF). We hypothesised that screening\u2010guided treatment with spironolactone would prevent incident HF in at\u2010risk patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>\n                      We randomised asymptomatic, community\u2010dwelling subjects aged \u226565\u2009years old, with at least one non\u2010ischaemic HF risk factor (hypertension, type 2 diabetes mellitus or obesity) to echocardiography\u2010guided therapy or usual care. Spironolactone therapy was triggered by the detection of subclinical LVD (global longitudinal strain [GLS] \u226416%) or diastolic abnormalities (at least one of E\/e\u2032\u2009&gt;15, E\/e\u2032\u2009&gt;10 with left atrial enlargement [LAE] or impaired relaxation [E\/A\u2009&lt;\u20090.8, IR], LAE with IR), or borderline GLS (17%) with IR or borderline GLS with LAE. The primary outcome was incident HF at 24\u2009months. Secondary outcomes were change in 6\u2010min walk test (6MWT) and change in left ventricular function. LVD was identified in 161 (46%) of 349 participants (age 70\u00a0[68\u201373] years, 201 [58%] women). The trial was stopped because of a 55% rate of spironolactone discontinuation, due primarily to decline in renal function. Incident HF developed in 11 (3.5%) of 310 participants completing follow\u2010up, with no difference between usual care and intervention (4 [2.5%] vs. 7 [4.7%],\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.29), decline in 6MWT distance (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.28), persistent or new LVD (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.58), nor change in GLS with intervention (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.15). A per\u2010protocol analysis of 131 patients with baseline LVD and a follow\u2010up echocardiogram, showed resolution of LVD with spironolactone therapy (59% vs. 33%,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.01).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The study was underpowered to determine whether screening\u2010guided spironolactone therapy reduced incident HF because spironolactone was frequently discontinued due to renal function criteria. However, LVD resolved in more patients treated with spironolactone than in untreated patients. Future trials should use less conservative renal criteria for spironolactone discontinuation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ejhf.2428","type":"journal-article","created":{"date-parts":[[2022,1,11]],"date-time":"2022-01-11T03:50:58Z","timestamp":1641873058000},"page":"620-630","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Screening\u2010guided spironolactone treatment of subclinical left ventricular dysfunction for heart failure prevention in at\u2010risk patients"],"prefix":"10.1093","volume":"24","author":[{"given":"Elizabeth","family":"Potter","sequence":"first","affiliation":[{"name":"Baker Heart and Diabetes Institute  Melbourne VIC Australia"},{"name":"School of Public Health and Preventive Medicine Monash University  Melbourne VIC Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Georgia","family":"Stephenson","sequence":"additional","affiliation":[{"name":"Baker Heart and Diabetes Institute  Melbourne VIC Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joanne","family":"Harris","sequence":"additional","affiliation":[{"name":"Baker Heart and Diabetes Institute  Melbourne VIC Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leah","family":"Wright","sequence":"additional","affiliation":[{"name":"Baker Heart and Diabetes Institute  Melbourne VIC Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas H.","family":"Marwick","sequence":"additional","affiliation":[{"name":"Baker Heart and Diabetes Institute  Melbourne VIC Australia"},{"name":"School of Public Health and Preventive Medicine Monash University  Melbourne VIC Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2022,1,27]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.289.2.194"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.292.3.344"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1161\/HHF.0b013e318291329a"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)32520-5"},{"key":"e_1_2_6_6_1","first-page":"e391","article-title":"Focused update incorporated into the ACC\/AHA 2005 guidelines for the diagnosis and management of heart failure in adults","volume":"119","author":"Hunt SA","year":"2009","journal-title":"Circulation"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.2333"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.04.025"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2014-305538"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2009.12.003"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2011.1201"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199909023411001"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.114.013255"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2010.06.052"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.905"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.118.011521"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehaa758"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2012-303329"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2011.08.014"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.c332"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2016.03.045"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/0021-9681(87)90171-8"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.166.1.at1102"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.111.964841"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2014.10.003"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2012.10.008"},{"key":"e_1_2_6_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2016.11.015"},{"key":"e_1_2_6_28_1","doi-asserted-by":"publisher","DOI":"10.1185\/03007990903126833"},{"key":"e_1_2_6_29_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM197112232852601"},{"key":"e_1_2_6_30_1","unstructured":"WilsonJ JungerG.Principles and Practice of Screening for Disease. 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