Evidence map›Paper›PMID 40736394›Full record

ArticleKorean circulation journal2025

Withdrawal of Spironolactone for Heart Failure With Improved Ejection Fraction: An Open-Label, Pilot, Randomized Controlled Trial (With-HF Trial).

Junho Hyun, Seung-Ah Lee, Sang Eun Lee, Jung Ae Hong, Min-Seok Kim, Jae-Joong Kim

Registry-linked trialAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Korean circulation journal, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04367051 (Withdrawal of Spironolactone Treatment for Heart Failure With Improved Left Ventricular Ejection Fractraction), which is not on this map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04367051 nacompletednot on this map

Withdrawal of Spironolactone Treatment for Heart Failure With Improved Left Ventricular Ejection Fractraction: an Open-label Randomized Controlled Pilot Study (With-HF Trial)

TypeinterventionalSponsorAsan Medical CenterRan2020 to 2022Enrolled62ConditionsHeart FailureArmsWithdrawal of Spironolactone, Continuation of spironolactone
3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Article
  3. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

6 authors.

Junho Hyun *Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.ORCID https://orcid.org/0000-0003-4211-3081
Seung-Ah Lee *Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.ORCID https://orcid.org/0000-0002-4093-7928
Sang Eun LeeDivision of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. sangeunlee.md@amc.seoul.kr.ORCID https://orcid.org/0000-0002-7290-2463
Jung Ae HongDepartment of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.ORCID https://orcid.org/0000-0003-3991-7353
Min-Seok KimDivision of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.ORCID https://orcid.org/0000-0003-0860-3650
Jae-Joong KimDivision of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.ORCID https://orcid.org/0000-0002-2714-2282

Funding

Asan Institute for Life Sciences, Asan Medical Center 2020IT0010
6 · The paper itself

Abstract

BACKGROUND AND

objectivesThe optimal strategy for the maintenance or discontinuation of evidence-based medication is unclear in heart failure (HF) patients with improved left ventricular ejection fraction (LVEF). We tested the feasibility and safety of withdrawing mineralocorticoid receptor antagonists (MRAs) in this population.

methodsThis is an open-label, prospective, randomized controlled pilot trial including HF patients whose LVEF improved from ≤35% to ≥50% after guideline-directed medical therapy. While testing withdrawal of MRA, other medications were maintained. The primary endpoint was the proportion of patients showing deteriorations in LVEF by ≥10% at 6-month follow-up. The secondary endpoints were numerical changes in echocardiographic parameters, changes in blood natriuretic peptide levels, and adverse clinical events relevant to HF.

resultsWe randomly assigned 62 HF patients with improved LVEF to the withdrawal or continuation groups. Two (6.7%) patients in the withdrawal group and one (3.2%) patient in the continuation group showed deterioration in LVEF by ≥10% at 6 months; one of the 2 patients in the withdrawal group who showed a decline in LVEF had LVEF of less than 50% at follow-up. Re-initiation of MRA did not occur in any patients. Compared with baseline, echocardiographic parameters, including LV end-diastolic volume index, global longitudinal strain, and natriuretic peptides, were similar at follow-up in both groups.

conclusionsMRA withdrawal was associated with a low risk of significant deterioration of cardiac function in HF patients with improved LVEF of ≥50%. MRA withdrawal may be feasible and safe in this population.

trial registrationClinicalTrials.gov Identifier: NCT04367051.

Indexed as

Heart failureMineralocorticoid receptor antagonistSpironolactoneWithholding treatment

Identifiers

PMID40736394
PMCPMC12705246

What Socratic holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.