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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.
Circ Heart Fail. 2014 Sep; 7(5):740-51.CH

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.

Authors+Show Affiliations

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.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.).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.).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.).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.).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.).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.).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.).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.).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.).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.).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.).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.).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.).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.).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.).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.).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.).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.).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.).

Pub Type(s)

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

Language

eng

PubMed ID

25122186

Citation

Shah, Amil M., et al. "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." Circulation. Heart Failure, vol. 7, no. 5, 2014, pp. 740-51.
Shah AM, Claggett B, Sweitzer NK, et al. 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. Circ Heart Fail. 2014;7(5):740-51.
Shah, A. M., Claggett, B., Sweitzer, N. K., Shah, S. J., Anand, I. S., O'Meara, E., Desai, A. S., Heitner, J. F., Li, G., Fang, J., Rouleau, J., Zile, M. R., Markov, V., Ryabov, V., Reis, G., Assmann, S. F., McKinlay, S. M., Pitt, B., Pfeffer, M. A., & Solomon, S. D. (2014). 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. Circulation. Heart Failure, 7(5), 740-51. https://doi.org/10.1161/CIRCHEARTFAILURE.114.001583
Shah AM, et al. 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. Circ Heart Fail. 2014;7(5):740-51. PubMed PMID: 25122186.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Shah,Amil M, AU - Claggett,Brian, AU - Sweitzer,Nancy K, AU - Shah,Sanjiv J, AU - Anand,Inder S, AU - O'Meara,Eileen, AU - Desai,Akshay S, AU - Heitner,John F, AU - Li,Guichu, AU - Fang,James, AU - Rouleau,Jean, AU - Zile,Michael R, AU - Markov,Valetin, AU - Ryabov,Vyacheslav, AU - Reis,Gilmar, AU - Assmann,Susan F, AU - McKinlay,Sonja M, AU - Pitt,Bertram, AU - Pfeffer,Marc A, AU - Solomon,Scott D, Y1 - 2014/08/13/ PY - 2014/8/15/entrez PY - 2014/8/15/pubmed PY - 2014/11/19/medline KW - clinical trial KW - echocardiography KW - heart failure SP - 740 EP - 51 JF - Circulation. Heart failure JO - Circ Heart Fail VL - 7 IS - 5 N2 - 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. SN - 1941-3297 UR - https://www.unboundmedicine.com/medline/citation/25122186/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_ L2 - http://www.ahajournals.org/doi/full/10.1161/CIRCHEARTFAILURE.114.001583?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -