• Amil M Shah, Brian Claggett, Nancy K Sweitzer, Sanjiv J Shah, Inder S Anand, Eileen O'Meara, Akshay S Desai, John F Heitner, Guichu Li, James Fang, Jean Rouleau, Michael R Zile, Valetin Markov, Vyacheslav Ryabov, Gilmar Reis, Susan F Assmann, Sonja M McKinlay, Bertram Pitt, Marc A Pfeffer, and Scott D Solomon.
• 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.
• Circ Heart Fail. 2014 Sep 1;7(5):740-51.

BackgroundAbnormalities 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 ResultsCardiac 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'.ConclusionsAmong 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 Urlhttp://www.clinicaltrials.gov. Unique identifier: NCT00094302.© 2014 American Heart Association, Inc.

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