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
Background—Abnormalities in cardiac structure and function in heart failure with preserved ejection fraction (HFpEF) 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 HFpEF (left ventricular ejection fraction [LVEF] ≥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 (CV) death, HF hospitalization, or aborted cardiac arrest, and its components. At a median follow-up of 2.9 years, 244 patients experienced the primary outcome. LV hypertrophy (LVH; adjusted HR 1.52, 95% CI 1.16-2.00), elevated LV filling pressure (E/E'; adjusted HR 1.05 per 1 integer increase; 95% CI 1.02-1.07), and higher pulmonary artery pressure assessed by the tricuspid regurgitation (TR) velocity (HR 1.23 per 0.5 m/sec increase; 95% CI 1.02-1.49) were associated with the composite outcome and HF hospitalization alone after adjusting for clinical and laboratory variables. The risk of adverse outcome associated with LVH was additive to the risk associated with elevated E/E'.
Conclusions—Among HFpEF patients enrolled in TOPCAT, LVH, higher LV filling pressure, and higher pulmonary artery pressure were predictive of HF hospitalization, CV death, or aborted cardiac arrest independent of clinical and laboratory predictors. These features, both alone and in combination, identify HFpEF patients at particularly high risk for CV morbidity and mortality.
Clinical Trial Registration—URL: http://www.clinicaltrials.gov. Unique identifier NCT00094302.
- Received May 8, 2014.
- Accepted July 31, 2014.