Trial reportJournal of the American Heart Association2020
Spironolactone in Atrial Fibrillation With Preserved Cardiac Fraction: The IMPRESS-AF Trial.
Trial report in Journal of the American Heart Association, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02673463 (Improved Exercise Tolerance in Participants With PReserved Ejection Fraction by Spironolactone on Myocardial Fibrosis in Atrial Fibrillation), which is not on this map. Cited by 17 papers, 1 of them a synthesis that pooled 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.
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.
Improved Exercise Tolerance in Participants With PReserved Ejection Fraction by Spironolactone on Myocardial Fibrosis in Atrial Fibrillation
Who cites it
17 citing papers in PubMed, 1 synthesis or guideline pooled it, 34 citations in OpenAlex.
- Meta-analysis addressing the impact of cardiovascular-acting medication on peak oxygen uptake of patients with HFpEF.Heart failure reviews · 2022Pooled it
- Low-dose digoxin improves cardiac function in patients with heart failure, preserved ejection fraction and atrial fibrillation - the RATE-AF randomized trial.European journal of heart failure · 2025Trial
- Effect of spironolactone on monocyte subsets in atrial fibrillation: IMPRESS-AF randomised controlled trial.Scientific reports · 2025Trial
- Spironolactone in Atrial Fibrillation With Preserved Cardiac Fraction: The IMPRESS-AF Trial.Journal of the American Heart Association · 2020Trial
- Bayes Syndrome and Myocardial Fibrosis: Mechanistic Links and Clinical Implications.Reviews in cardiovascular medicine · 2026Review
- Heart failure with preserved ejection fraction for the clinician - highlights from the 5th annual Charleston HFpEF conference.Heart failure reviews · 2026Article
- Preserved Ejection, Lost Rhythm: A Narrative Review of the Pathophysiology and Management of Heart Failure with Preserved Ejection Fraction and Concomitant Atrial Fibrillation.Journal of clinical medicine · 2026Review
- Management of atrial fibrillation in patients with heart failure with preserved ejection fraction.Heart failure reviews · 2025Review
- The left atrium in heart failure with preserved ejection fraction: What we know and what we do not know.Heart rhythm O2 · 2025Review
- Time's imprint on the left atrium: aging and atrial myopathy.The journal of cardiovascular aging · 2025Article
- Mineralocorticoid Receptor Antagonists in Heart Failure with Preserved Ejection Fraction: A Systematic Review and Meta-Analysis.Journal of clinical medicine · 2025Review
- Vascular Endothelial Barrier Protection Prevents Atrial Fibrillation by Preserving Cardiac Nanostructure.JACC. Clinical electrophysiology · 2023Article
- A review of the impact, pathophysiology, and management of atrial fibrillation in patients with heart failure with preserved ejection fraction.American heart journal plus : cardiology research and practice · 2023Review
- Characteristics, prognosis, and treatment response in HFpEF patients with high vs. normal ejection fraction.Frontiers in cardiovascular medicine · 2022Article
- Breaking the Cycle of Heart Failure With Preserved Ejection Fraction and Atrial Fibrillation.Cardiac failure review · 2022Review
- Left Atrial Myopathy in Atrial Fibrillation and Heart Failure: Clinical Implications, Mechanisms, and Therapeutic Targets.Current heart failure reports · 2021Review
- Aldosterone Antagonism in Atrial Fibrillation: Implications for AF-Predominant HFpEF.Journal of the American Heart Association · 2020Article
Corrections and comments
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Authors and funding
9 authors at 8 institutions in 4 countries.
Funding
Abstract
Background Patients with permanent atrial fibrillation have poor outcomes, exercise capacity, and quality of life even on optimal anticoagulation. Based on mechanistic and observational data, we tested whether the mineralocorticoid receptor antagonist spironolactone can improve exercise capacity, E/e' ratio, and quality of life in patients with permanent atrial fibrillation and preserved ejection fraction. Methods and Results The double-masked, placebo-controlled IMPRESS-AF (Improved Exercise Tolerance in Heart Failure With Preserved Ejection Fraction by Spironolactone on Myocardial Fibrosis in Atrial Fibrillation) trial (NCT02673463) randomized 250 stable patients with permanent atrial fibrillation and preserved left ventricular ejection fraction to spironolactone 25 mg daily or placebo. Patients were followed for 2 years. The primary efficacy outcome was peak oxygen consumption on cardiopulmonary exercise testing at 2 years. Secondary end points included 6-minute walk distance, E/e' ratio, quality of life, and hospital admissions. Spironolactone therapy did not improve peak oxygen consumption at 2 years (14.0 mL/min per kg [SD, 5.4]) compared with placebo (14.5 [5.1], adjusted treatment effect, -0.28; 95% CI, -1.27 to 0.71];
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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 OpenQuestion graph.