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Updated: Oct 13, 2025
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Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
Published on: February 13, 2021
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Weight changes in heart failure with preserved ejection fraction: findings from TOPCAT
João Pedro Ferreira1,2, Patrick Rossignol3, Brian L Claggett4
1Centre d'Investigations Cliniques Plurithématique 1433, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Université de Lorraine, Inserm, Inserm U1116, CHRU Nancy - Hopitaux de Brabois, Institut Lorrain du Coeur Et Des Vaisseaux Louis Mathieu, 4 rue du Morvan, 54500, Vandoeuvre les Nancy, France. j.ferreira@chru-nancy.fr.
Summary
Significant weight loss in heart failure with preserved ejection fraction (HFpEF) patients is common and linked to increased mortality. Spironolactone offers minimal early weight reduction, with no long-term impact on weight changes or survival.
Area of Science:
- Cardiology
- Clinical Trials
- Heart Failure Research
Background:
- Weight loss is linked to adverse outcomes in heart failure (HF).
- Limited data exist on weight changes in heart failure with preserved ejection fraction (HFpEF).
- The impact of weight gain on HFpEF outcomes is underreported.
Purpose of the Study:
- To investigate post-randomization weight changes in HFpEF patients.
- To assess the impact of weight changes on outcomes in HFpEF.
- To evaluate the effect of spironolactone on weight and outcomes in HFpEF.
Main Methods:
- Utilized mixed-effects regressions and time-updated Cox models.
- Analyzed factors associated with weight changes.
- Assessed the impact of weight changes on subsequent outcomes in the TOPCAT-Americas trial.
Main Results:
- Nearly half of HFpEF patients (47%) experienced ≥5% weight loss over 3 years.
- Weight loss was more common in older women with severe HF symptoms.
- Weight loss ≥5% was associated with increased cardiovascular and all-cause mortality (HR 1.47 and 1.84, respectively).
- Spironolactone caused minor early weight reduction (≤12 months) but had no later effect.
- Spironolactone reduced the odds of weight gain but not weight loss.
Conclusions:
- Weight loss ≥5% is frequent in HFpEF and independently predicts higher mortality.
- Spironolactone demonstrates limited efficacy in inducing sustained weight reduction.
- Body weight changes are significantly associated with subsequent mortality risk in HFpEF.
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