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Randomized Controlled Trial
. 2014 Sep;7(5):740-51.
doi: 10.1161/CIRCHEARTFAILURE.114.001583. Epub 2014 Aug 13.

Cardiac structure and function and prognosis in heart failure with preserved ejection fraction: findings from the echocardiographic study of the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) Trial

Amil M Shah  1 , Brian Claggett  2 , Nancy K Sweitzer  2 , Sanjiv J Shah  2 , Inder S Anand  2 , Eileen O'Meara  2 , Akshay S Desai  2 , John F Heitner  2 , Guichu Li  2 , James Fang  2 , Jean Rouleau  2 , Michael R Zile  2 , Valetin Markov  2 , Vyacheslav Ryabov  2 , Gilmar Reis  2 , Susan F Assmann  2 , Sonja M McKinlay  2 , Bertram Pitt  2 , Marc A Pfeffer  2 , Scott D Solomon  2
Affiliations
Randomized Controlled Trial

Cardiac structure and function and prognosis in heart failure with preserved ejection fraction: findings from the echocardiographic study of the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) Trial

Amil M Shah et al. Circ Heart Fail. 2014 Sep.

Abstract

Background: Abnormalities in cardiac structure and function in heart failure with preserved ejection fraction may help identify patients at particularly high risk for cardiovascular morbidity and mortality.

Methods and results: Cardiac structure and function were assessed by echocardiography in a blinded core laboratory at baseline in 935 patients with heart failure with preserved ejection fraction (left ventricular ejection fraction ≥45%) enrolled in the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial and related to the primary composite outcome of cardiovascular death, heart failure hospitalization, or aborted cardiac arrest, and its components. At a median follow-up of 2.9 years, 244 patients experienced the primary outcome. Left ventricular hypertrophy (adjusted hazard ratio, 1.52; 95% confidence interval, 1.16-2.00), elevated left ventricular filling pressure (E/E'; adjusted hazard ratio 1.05 per 1 integer increase; 95% confidence interval, 1.02-1.07), and higher pulmonary artery pressure assessed by the tricuspid regurgitation velocity (hazard ratio, 1.23 per 0.5 m/s increase; 95% confidence interval, 1.02-1.49) were associated with the composite outcome and heart failure hospitalization alone after adjusting for clinical and laboratory variables. The risk of adverse outcome associated with left ventricular hypertrophy was additive to the risk associated with elevated E/E'.

Conclusions: Among heart failure with preserved ejection fraction patients enrolled in TOPCAT, left ventricular hypertrophy, higher left ventricular filling pressure, and higher pulmonary artery pressure were predictive of heart failure hospitalization, cardiovascular death, or aborted cardiac arrest independent of clinical and laboratory predictors. These features, both alone and in combination, identify heart failure with preserved ejection fraction patients at particularly high risk for cardiovascular morbidity and mortality.

Clinical trial registration url: http://www.clinicaltrials.gov. Unique identifier: NCT00094302.

Keywords: clinical trial; echocardiography; heart failure.

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Figures

Figure 1
Figure 1
Enrollment in the TOPCAT echocardiography study.
Figure 2
Figure 2
Pie charts demonstrating the prevalence of (A) LV geometry (n=875), (B) left atrial enlargement (n=836), and (C) LV diastolic dysfunction grade in the TOPCAT echocardiography study (n=490).
See this image and copyright information in PMC

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