Heart failure & cardiomyopathies
Soluble Urokinase Plasminogen Activator Receptor and Outcomes in Heart Failure with Preserved Ejection Fraction (HFpEF): A TOPCAT Ancillary Study
Primary result · Primary outcome, 5-year cumulative incidence by suPAR tertileResult — go to the resultHazard ratio 1.94 95% CI 1.33–2.83Authors' conclusion
While suPAR levels independently predict poor outcomes in HFpEF patients, spironolactone does not modulate this inflammatory pathway.
Study context
- Population
- Patients with HFpEF in the TOPCAT North American cohort treated with spironolactone or placebo, soluble urokinase plasminogen activator receptor (suPAR) measured at baseline and 1 year
- Participants
- 406 patients
- Comparison
- Highest vs lowest tertile of baseline suPAR
- Primary endpoint
- Composite of:
- CV death
- Cardiac arrest
- Hospitalization for HF management
Methodological detailsNorth American cohort, ancillary biomarker study, Mean age 69.5 years; 46.6% female, Median follow-up 2.9 years
- North American cohort
- Ancillary biomarker study
- Mean age 69.5 years; 46.6% female
- Median follow-up 2.9 years
Primary result
As reported in the abstract
Primary outcome, 5-year cumulative incidence by suPAR tertile · 5 years
Hazard ratio
1.94
95% CI 1.33–2.83
By group
Each doubling of baseline suPAR
HR 1.94 (95% CI 1.33–2.83)
Each doubling of baseline suPAR, as printed
- Primary outcome event after median follow-up 2.9 years
- 19.9%
Further findings
Effect of spironolactone on suPAR levels · 1 year
- Spironolactone did not significantly change suPAR levels
Spironolactone effect on outcomes by baseline suPAR
- Effect not modified by baseline suPAR
- P for interaction = 0.6
Risk discrimination
- suPAR's risk discrimination superior and additive to that of natriuretic peptide (NP)
Original publication
Soluble Urokinase Plasminogen Activator Receptor and Outcomes in HFpEF: A TOPCAT Ancillary Study. ESC Heart Fail. Published 17 September 2025. doi:10.
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