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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.
Circ Heart Fail. 2014 Jan; 7(1):104-15.CH

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.

METHODS AND 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.

CLINICAL TRIAL REGISTRATION

URL: http://www.clinicaltrials.gov. Unique identifier: NCT00094302.

Authors+Show Affiliations

Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

24249049

Citation

Shah, Amil M., et al. "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." Circulation. Heart Failure, vol. 7, no. 1, 2014, pp. 104-15.
Shah AM, Shah SJ, Anand IS, et al. 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. Circ Heart Fail. 2014;7(1):104-15.
Shah, A. M., Shah, S. J., Anand, I. S., Sweitzer, N. K., O'Meara, E., Heitner, J. F., Sopko, G., Li, G., Assmann, S. F., McKinlay, S. M., Pitt, B., Pfeffer, M. A., & Solomon, S. D. (2014). 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. Circulation. Heart Failure, 7(1), 104-15. https://doi.org/10.1161/CIRCHEARTFAILURE.113.000887
Shah AM, et al. 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. Circ Heart Fail. 2014;7(1):104-15. PubMed PMID: 24249049.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Shah,Amil M, AU - Shah,Sanjiv J, AU - Anand,Inder S, AU - Sweitzer,Nancy K, AU - O'Meara,Eileen, AU - Heitner,John F, AU - Sopko,George, AU - Li,Guichu, AU - Assmann,Susan F, AU - McKinlay,Sonja M, AU - Pitt,Bertram, AU - Pfeffer,Marc A, AU - Solomon,Scott D, AU - ,, Y1 - 2013/11/18/ PY - 2013/11/20/entrez PY - 2013/11/20/pubmed PY - 2014/5/28/medline KW - diastolic heart failure KW - echocardiography KW - heart failure KW - randomized controlled trial KW - spironolactone SP - 104 EP - 15 JF - Circulation. Heart failure JO - Circ Heart Fail VL - 7 IS - 1 N2 - 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. METHODS AND 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. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00094302. SN - 1941-3297 UR - https://www.unboundmedicine.com/medline/citation/24249049/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_ L2 - http://www.ahajournals.org/doi/full/10.1161/CIRCHEARTFAILURE.113.000887?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -