title: 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.
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.
  
  
  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.
  
  
  BACKGROUND
  http://www.clinicaltrials.gov. Unique identifier: NCT00094302.
authors.affiliation: From the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., A.S.D., G.L., M.A.P., S.D.S.); University of Wisconsin Hospital and Clinics, Madison (N.K.S.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); VA Medical Center, Minneapolis, MN (I.S.A.); Montreal Heart Institute, Montreal, Canada (E.O., J.R.); New York Methodist Hospital, Brooklyn (J.F.H.); University of Utah School of Medicine, Salt Lake City (J.F.); Medical University of South Carolina, Charleston (M.R.Z.); Research Cardiology Institute Tomsk Scientific Center, Tomsk, Russia (V.M., V.R.); Santa Casa de Belo Horizonte, Belo Horizonte, Brazil (G.R.); New England Research Institutes, Watertown, MA (S.F.A., S.M.M.); and University of Michigan School of Medicine, Ann Arbor (B.P.). ashah11@partners.org.
authors.forename: Amil M
authors.initials: AM
authors.lastname: Shah
authors.affiliation: From the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., A.S.D., G.L., M.A.P., S.D.S.); University of Wisconsin Hospital and Clinics, Madison (N.K.S.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); VA Medical Center, Minneapolis, MN (I.S.A.); Montreal Heart Institute, Montreal, Canada (E.O., J.R.); New York Methodist Hospital, Brooklyn (J.F.H.); University of Utah School of Medicine, Salt Lake City (J.F.); Medical University of South Carolina, Charleston (M.R.Z.); Research Cardiology Institute Tomsk Scientific Center, Tomsk, Russia (V.M., V.R.); Santa Casa de Belo Horizonte, Belo Horizonte, Brazil (G.R.); New England Research Institutes, Watertown, MA (S.F.A., S.M.M.); and University of Michigan School of Medicine, Ann Arbor (B.P.).
authors.forename: Brian
authors.initials: B
authors.lastname: Claggett
authors.affiliation: From the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., A.S.D., G.L., M.A.P., S.D.S.); University of Wisconsin Hospital and Clinics, Madison (N.K.S.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); VA Medical Center, Minneapolis, MN (I.S.A.); Montreal Heart Institute, Montreal, Canada (E.O., J.R.); New York Methodist Hospital, Brooklyn (J.F.H.); University of Utah School of Medicine, Salt Lake City (J.F.); Medical University of South Carolina, Charleston (M.R.Z.); Research Cardiology Institute Tomsk Scientific Center, Tomsk, Russia (V.M., V.R.); Santa Casa de Belo Horizonte, Belo Horizonte, Brazil (G.R.); New England Research Institutes, Watertown, MA (S.F.A., S.M.M.); and University of Michigan School of Medicine, Ann Arbor (B.P.).
authors.forename: Nancy K
authors.initials: NK
authors.lastname: Sweitzer
authors.affiliation: From the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., A.S.D., G.L., M.A.P., S.D.S.); University of Wisconsin Hospital and Clinics, Madison (N.K.S.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); VA Medical Center, Minneapolis, MN (I.S.A.); Montreal Heart Institute, Montreal, Canada (E.O., J.R.); New York Methodist Hospital, Brooklyn (J.F.H.); University of Utah School of Medicine, Salt Lake City (J.F.); Medical University of South Carolina, Charleston (M.R.Z.); Research Cardiology Institute Tomsk Scientific Center, Tomsk, Russia (V.M., V.R.); Santa Casa de Belo Horizonte, Belo Horizonte, Brazil (G.R.); New England Research Institutes, Watertown, MA (S.F.A., S.M.M.); and University of Michigan School of Medicine, Ann Arbor (B.P.).
authors.forename: Sanjiv J
authors.initials: SJ
authors.lastname: Shah
authors.affiliation: From the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., A.S.D., G.L., M.A.P., S.D.S.); University of Wisconsin Hospital and Clinics, Madison (N.K.S.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); VA Medical Center, Minneapolis, MN (I.S.A.); Montreal Heart Institute, Montreal, Canada (E.O., J.R.); New York Methodist Hospital, Brooklyn (J.F.H.); University of Utah School of Medicine, Salt Lake City (J.F.); Medical University of South Carolina, Charleston (M.R.Z.); Research Cardiology Institute Tomsk Scientific Center, Tomsk, Russia (V.M., V.R.); Santa Casa de Belo Horizonte, Belo Horizonte, Brazil (G.R.); New England Research Institutes, Watertown, MA (S.F.A., S.M.M.); and University of Michigan School of Medicine, Ann Arbor (B.P.).
authors.forename: Inder S
authors.initials: IS
authors.lastname: Anand
authors.affiliation: From the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., A.S.D., G.L., M.A.P., S.D.S.); University of Wisconsin Hospital and Clinics, Madison (N.K.S.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); VA Medical Center, Minneapolis, MN (I.S.A.); Montreal Heart Institute, Montreal, Canada (E.O., J.R.); New York Methodist Hospital, Brooklyn (J.F.H.); University of Utah School of Medicine, Salt Lake City (J.F.); Medical University of South Carolina, Charleston (M.R.Z.); Research Cardiology Institute Tomsk Scientific Center, Tomsk, Russia (V.M., V.R.); Santa Casa de Belo Horizonte, Belo Horizonte, Brazil (G.R.); New England Research Institutes, Watertown, MA (S.F.A., S.M.M.); and University of Michigan School of Medicine, Ann Arbor (B.P.).
authors.forename: Eileen
authors.initials: E
authors.lastname: O'Meara
authors.affiliation: From the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., A.S.D., G.L., M.A.P., S.D.S.); University of Wisconsin Hospital and Clinics, Madison (N.K.S.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); VA Medical Center, Minneapolis, MN (I.S.A.); Montreal Heart Institute, Montreal, Canada (E.O., J.R.); New York Methodist Hospital, Brooklyn (J.F.H.); University of Utah School of Medicine, Salt Lake City (J.F.); Medical University of South Carolina, Charleston (M.R.Z.); Research Cardiology Institute Tomsk Scientific Center, Tomsk, Russia (V.M., V.R.); Santa Casa de Belo Horizonte, Belo Horizonte, Brazil (G.R.); New England Research Institutes, Watertown, MA (S.F.A., S.M.M.); and University of Michigan School of Medicine, Ann Arbor (B.P.).
authors.forename: Akshay S
authors.initials: AS
authors.lastname: Desai
authors.affiliation: From the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., A.S.D., G.L., M.A.P., S.D.S.); University of Wisconsin Hospital and Clinics, Madison (N.K.S.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); VA Medical Center, Minneapolis, MN (I.S.A.); Montreal Heart Institute, Montreal, Canada (E.O., J.R.); New York Methodist Hospital, Brooklyn (J.F.H.); University of Utah School of Medicine, Salt Lake City (J.F.); Medical University of South Carolina, Charleston (M.R.Z.); Research Cardiology Institute Tomsk Scientific Center, Tomsk, Russia (V.M., V.R.); Santa Casa de Belo Horizonte, Belo Horizonte, Brazil (G.R.); New England Research Institutes, Watertown, MA (S.F.A., S.M.M.); and University of Michigan School of Medicine, Ann Arbor (B.P.).
authors.forename: John F
authors.initials: JF
authors.lastname: Heitner
authors.affiliation: From the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., A.S.D., G.L., M.A.P., S.D.S.); University of Wisconsin Hospital and Clinics, Madison (N.K.S.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); VA Medical Center, Minneapolis, MN (I.S.A.); Montreal Heart Institute, Montreal, Canada (E.O., J.R.); New York Methodist Hospital, Brooklyn (J.F.H.); University of Utah School of Medicine, Salt Lake City (J.F.); Medical University of South Carolina, Charleston (M.R.Z.); Research Cardiology Institute Tomsk Scientific Center, Tomsk, Russia (V.M., V.R.); Santa Casa de Belo Horizonte, Belo Horizonte, Brazil (G.R.); New England Research Institutes, Watertown, MA (S.F.A., S.M.M.); and University of Michigan School of Medicine, Ann Arbor (B.P.).
authors.forename: Guichu
authors.initials: G
authors.lastname: Li
authors.affiliation: From the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., A.S.D., G.L., M.A.P., S.D.S.); University of Wisconsin Hospital and Clinics, Madison (N.K.S.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); VA Medical Center, Minneapolis, MN (I.S.A.); Montreal Heart Institute, Montreal, Canada (E.O., J.R.); New York Methodist Hospital, Brooklyn (J.F.H.); University of Utah School of Medicine, Salt Lake City (J.F.); Medical University of South Carolina, Charleston (M.R.Z.); Research Cardiology Institute Tomsk Scientific Center, Tomsk, Russia (V.M., V.R.); Santa Casa de Belo Horizonte, Belo Horizonte, Brazil (G.R.); New England Research Institutes, Watertown, MA (S.F.A., S.M.M.); and University of Michigan School of Medicine, Ann Arbor (B.P.).
authors.forename: James
authors.initials: J
authors.lastname: Fang
authors.affiliation: From the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., A.S.D., G.L., M.A.P., S.D.S.); University of Wisconsin Hospital and Clinics, Madison (N.K.S.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); VA Medical Center, Minneapolis, MN (I.S.A.); Montreal Heart Institute, Montreal, Canada (E.O., J.R.); New York Methodist Hospital, Brooklyn (J.F.H.); University of Utah School of Medicine, Salt Lake City (J.F.); Medical University of South Carolina, Charleston (M.R.Z.); Research Cardiology Institute Tomsk Scientific Center, Tomsk, Russia (V.M., V.R.); Santa Casa de Belo Horizonte, Belo Horizonte, Brazil (G.R.); New England Research Institutes, Watertown, MA (S.F.A., S.M.M.); and University of Michigan School of Medicine, Ann Arbor (B.P.).
authors.forename: Jean
authors.initials: J
authors.lastname: Rouleau
authors.affiliation: From the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., A.S.D., G.L., M.A.P., S.D.S.); University of Wisconsin Hospital and Clinics, Madison (N.K.S.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); VA Medical Center, Minneapolis, MN (I.S.A.); Montreal Heart Institute, Montreal, Canada (E.O., J.R.); New York Methodist Hospital, Brooklyn (J.F.H.); University of Utah School of Medicine, Salt Lake City (J.F.); Medical University of South Carolina, Charleston (M.R.Z.); Research Cardiology Institute Tomsk Scientific Center, Tomsk, Russia (V.M., V.R.); Santa Casa de Belo Horizonte, Belo Horizonte, Brazil (G.R.); New England Research Institutes, Watertown, MA (S.F.A., S.M.M.); and University of Michigan School of Medicine, Ann Arbor (B.P.).
authors.forename: Michael R
authors.initials: MR
authors.lastname: Zile
authors.affiliation: From the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., A.S.D., G.L., M.A.P., S.D.S.); University of Wisconsin Hospital and Clinics, Madison (N.K.S.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); VA Medical Center, Minneapolis, MN (I.S.A.); Montreal Heart Institute, Montreal, Canada (E.O., J.R.); New York Methodist Hospital, Brooklyn (J.F.H.); University of Utah School of Medicine, Salt Lake City (J.F.); Medical University of South Carolina, Charleston (M.R.Z.); Research Cardiology Institute Tomsk Scientific Center, Tomsk, Russia (V.M., V.R.); Santa Casa de Belo Horizonte, Belo Horizonte, Brazil (G.R.); New England Research Institutes, Watertown, MA (S.F.A., S.M.M.); and University of Michigan School of Medicine, Ann Arbor (B.P.).
authors.forename: Valetin
authors.initials: V
authors.lastname: Markov
authors.affiliation: From the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., A.S.D., G.L., M.A.P., S.D.S.); University of Wisconsin Hospital and Clinics, Madison (N.K.S.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); VA Medical Center, Minneapolis, MN (I.S.A.); Montreal Heart Institute, Montreal, Canada (E.O., J.R.); New York Methodist Hospital, Brooklyn (J.F.H.); University of Utah School of Medicine, Salt Lake City (J.F.); Medical University of South Carolina, Charleston (M.R.Z.); Research Cardiology Institute Tomsk Scientific Center, Tomsk, Russia (V.M., V.R.); Santa Casa de Belo Horizonte, Belo Horizonte, Brazil (G.R.); New England Research Institutes, Watertown, MA (S.F.A., S.M.M.); and University of Michigan School of Medicine, Ann Arbor (B.P.).
authors.forename: Vyacheslav
authors.initials: V
authors.lastname: Ryabov
authors.affiliation: From the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., A.S.D., G.L., M.A.P., S.D.S.); University of Wisconsin Hospital and Clinics, Madison (N.K.S.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); VA Medical Center, Minneapolis, MN (I.S.A.); Montreal Heart Institute, Montreal, Canada (E.O., J.R.); New York Methodist Hospital, Brooklyn (J.F.H.); University of Utah School of Medicine, Salt Lake City (J.F.); Medical University of South Carolina, Charleston (M.R.Z.); Research Cardiology Institute Tomsk Scientific Center, Tomsk, Russia (V.M., V.R.); Santa Casa de Belo Horizonte, Belo Horizonte, Brazil (G.R.); New England Research Institutes, Watertown, MA (S.F.A., S.M.M.); and University of Michigan School of Medicine, Ann Arbor (B.P.).
authors.forename: Gilmar
authors.initials: G
authors.lastname: Reis
authors.affiliation: From the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., A.S.D., G.L., M.A.P., S.D.S.); University of Wisconsin Hospital and Clinics, Madison (N.K.S.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); VA Medical Center, Minneapolis, MN (I.S.A.); Montreal Heart Institute, Montreal, Canada (E.O., J.R.); New York Methodist Hospital, Brooklyn (J.F.H.); University of Utah School of Medicine, Salt Lake City (J.F.); Medical University of South Carolina, Charleston (M.R.Z.); Research Cardiology Institute Tomsk Scientific Center, Tomsk, Russia (V.M., V.R.); Santa Casa de Belo Horizonte, Belo Horizonte, Brazil (G.R.); New England Research Institutes, Watertown, MA (S.F.A., S.M.M.); and University of Michigan School of Medicine, Ann Arbor (B.P.).
authors.forename: Susan F
authors.initials: SF
authors.lastname: Assmann
authors.affiliation: From the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., A.S.D., G.L., M.A.P., S.D.S.); University of Wisconsin Hospital and Clinics, Madison (N.K.S.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); VA Medical Center, Minneapolis, MN (I.S.A.); Montreal Heart Institute, Montreal, Canada (E.O., J.R.); New York Methodist Hospital, Brooklyn (J.F.H.); University of Utah School of Medicine, Salt Lake City (J.F.); Medical University of South Carolina, Charleston (M.R.Z.); Research Cardiology Institute Tomsk Scientific Center, Tomsk, Russia (V.M., V.R.); Santa Casa de Belo Horizonte, Belo Horizonte, Brazil (G.R.); New England Research Institutes, Watertown, MA (S.F.A., S.M.M.); and University of Michigan School of Medicine, Ann Arbor (B.P.).
authors.forename: Sonja M
authors.initials: SM
authors.lastname: McKinlay
authors.affiliation: From the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., A.S.D., G.L., M.A.P., S.D.S.); University of Wisconsin Hospital and Clinics, Madison (N.K.S.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); VA Medical Center, Minneapolis, MN (I.S.A.); Montreal Heart Institute, Montreal, Canada (E.O., J.R.); New York Methodist Hospital, Brooklyn (J.F.H.); University of Utah School of Medicine, Salt Lake City (J.F.); Medical University of South Carolina, Charleston (M.R.Z.); Research Cardiology Institute Tomsk Scientific Center, Tomsk, Russia (V.M., V.R.); Santa Casa de Belo Horizonte, Belo Horizonte, Brazil (G.R.); New England Research Institutes, Watertown, MA (S.F.A., S.M.M.); and University of Michigan School of Medicine, Ann Arbor (B.P.).
authors.forename: Bertram
authors.initials: B
authors.lastname: Pitt
authors.affiliation: From the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., A.S.D., G.L., M.A.P., S.D.S.); University of Wisconsin Hospital and Clinics, Madison (N.K.S.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); VA Medical Center, Minneapolis, MN (I.S.A.); Montreal Heart Institute, Montreal, Canada (E.O., J.R.); New York Methodist Hospital, Brooklyn (J.F.H.); University of Utah School of Medicine, Salt Lake City (J.F.); Medical University of South Carolina, Charleston (M.R.Z.); Research Cardiology Institute Tomsk Scientific Center, Tomsk, Russia (V.M., V.R.); Santa Casa de Belo Horizonte, Belo Horizonte, Brazil (G.R.); New England Research Institutes, Watertown, MA (S.F.A., S.M.M.); and University of Michigan School of Medicine, Ann Arbor (B.P.).
authors.forename: Marc A
authors.initials: MA
authors.lastname: Pfeffer
authors.affiliation: From the Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (A.M.S., B.C., A.S.D., G.L., M.A.P., S.D.S.); University of Wisconsin Hospital and Clinics, Madison (N.K.S.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); VA Medical Center, Minneapolis, MN (I.S.A.); Montreal Heart Institute, Montreal, Canada (E.O., J.R.); New York Methodist Hospital, Brooklyn (J.F.H.); University of Utah School of Medicine, Salt Lake City (J.F.); Medical University of South Carolina, Charleston (M.R.Z.); Research Cardiology Institute Tomsk Scientific Center, Tomsk, Russia (V.M., V.R.); Santa Casa de Belo Horizonte, Belo Horizonte, Brazil (G.R.); New England Research Institutes, Watertown, MA (S.F.A., S.M.M.); and University of Michigan School of Medicine, Ann Arbor (B.P.).
authors.forename: Scott D
authors.initials: SD
authors.lastname: Solomon
mesh_terms: D000368:Aged; D004311:Double-Blind Method; D015150:Echocardiography, Doppler / Q000379:methods*; D005500:Follow-Up Studies; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000503:physiopathology; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use*; D011379:Prognosis; D013148:Spironolactone / Q000627:therapeutic use*; D013318:Stroke Volume / Q000502:physiology*; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology*
chemical_list: D000451:Mineralocorticoid Receptor Antagonists; D013148:Spironolactone
keywords: clinical trial; echocardiography; heart failure