title: Cardiac structure and function in heart failure with preserved ejection fraction: baseline findings from the echocardiographic study of the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist trial.
abstract: BACKGROUND
  Heart failure with preserved ejection fraction (HFpEF) is associated with substantial morbidity and mortality. Existing data on cardiac structure and function in HFpEF suggest significant heterogeneity in this population.
  
  
  RESULTS
  Echocardiograms were obtained from 935 patients with HFpEF (left ventricular ejection fraction ≥45%) enrolled in the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial before initiation of randomized therapy. Average age was 70±10 years, 49% were women, 14% were of African descent, and comorbidities were highly prevalent. Centralized quantitative analysis in a blinded core laboratory demonstrated a mean left ventricular ejection fraction of 59.3±7.9%, with prevalent concentric left ventricular remodeling (34%) and hypertrophy (43%), and left atrial enlargement (53%). Diastolic dysfunction was present in 66% of gradable participants and was significantly associated with greater left ventricular hypertrophy and a higher prevalence of left atrial enlargement. Doppler evidence of pulmonary hypertension was present in 36%. At least 1 measure of structural heart disease was present in 93% of patients.
  
  
  CONCLUSIONS
  Patients enrolled in TOPCAT demonstrated heterogeneous patterns of ventricular remodeling, with high prevalence of structural heart disease, including left ventricular hypertrophy and left atrial enlargement, in addition to pulmonary hypertension, each of which has been associated with adverse outcomes in HFpEF. Diastolic function was normal in approximately one third of gradable participants, highlighting the heterogeneity of the cardiac phenotype in this syndrome. These findings deepen our understanding of the TOPCAT trial population and expand our knowledge of the diversity of the cardiac phenotype in HFpEF.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT00094302.
authors.affiliation: Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA.
authors.forename: Amil M
authors.initials: AM
authors.lastname: Shah
authors.forename: Sanjiv J
authors.initials: SJ
authors.lastname: Shah
authors.forename: Inder S
authors.initials: IS
authors.lastname: Anand
authors.forename: Nancy K
authors.initials: NK
authors.lastname: Sweitzer
authors.forename: Eileen
authors.initials: E
authors.lastname: O'Meara
authors.forename: John F
authors.initials: JF
authors.lastname: Heitner
authors.forename: George
authors.initials: G
authors.lastname: Sopko
authors.forename: Guichu
authors.initials: G
authors.lastname: Li
authors.forename: Susan F
authors.initials: SF
authors.lastname: Assmann
authors.forename: Sonja M
authors.initials: SM
authors.lastname: McKinlay
authors.forename: Bertram
authors.initials: B
authors.lastname: Pitt
authors.forename: Marc A
authors.initials: MA
authors.lastname: Pfeffer
authors.forename: Scott D
authors.initials: SD
authors.lastname: Solomon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004311:Double-Blind Method; D004452:Echocardiography; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D006333:Heart Failure / Q000188:drug therapy / Q000473:pathology* / Q000503:physiopathology*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging / Q000473:pathology; D006984:Hypertrophy / Q000453:epidemiology; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology; D015994:Incidence; D007391:International Cooperation; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000009:adverse effects / Q000627:therapeutic use; D009206:Myocardium / Q000473:pathology*; D010641:Phenotype; D013148:Spironolactone / Q000009:adverse effects / Q000627:therapeutic use; D013318:Stroke Volume / Q000502:physiology*; D016896:Treatment Outcome; D020257:Ventricular Remodeling / Q000502:physiology
chemical_list: D000451:Mineralocorticoid Receptor Antagonists; D013148:Spironolactone
keywords: diastolic heart failure; echocardiography; heart failure; randomized controlled trial; spironolactone