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.
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.
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DOI：
10.1161/circheartfailure.113.000887
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发表时间：
2014-01
期刊：
影响因子：
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通讯作者：
TOPCAT Investigators
中科院分区：
文献类型：
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作者：
Shah AM;Shah SJ;Anand IS;Sweitzer NK;O'Meara E;Heitner JF;Sopko G;Li G;Assmann SF;McKinlay SM;Pitt B;Pfeffer MA;Solomon SD;TOPCAT Investigators
射血分数保留性心力衰竭（HFpEF）与大量发病率和死亡率相关。HFpEF患者心脏结构和功能的现有数据表明该人群存在显著异质性。在开始随机治疗前，从935例入选醛固酮拮抗剂治疗保留心功能心力衰竭（TOPCAT）试验的HFpEF（左心室射血分数[LVEF] ≥45%）患者中获得超声心动图。平均年龄为70±10岁，49%为女性，14%为非洲裔，合并症非常普遍。设盲核心实验室的集中定量分析显示平均LVEF为59.3± 7.9%，普遍存在向心性LV重构（34%）和肥大（43%）以及左心房（LA）增大（53%）。66%的可分级参与者存在舒张功能障碍，并且与更大的LV肥大和更高的LA扩大患病率显著相关。36%的患者存在肺动脉高压的多普勒证据。在93%的患者中存在至少1种结构性心脏病指标。入组TOPCAT的受试者表现出心室重塑的异质性模式，除了肺动脉高压外，结构性心脏病（包括LV肥大和LA扩大）的患病率较高，每种疾病均与HFpEF的不良结局相关。大约三分之一的可分级参与者的舒张功能正常，突出了该综合征心脏表型的异质性。这些发现加深了我们对TOPCAT试验人群的理解，并扩展了我们对HFpEF心脏表型多样性的认识。Clinicaltrials.gov标识符NCT 00094302
Heart failure with preserved ejection fraction (HFpEF) is associated with substantial morbidity and mortality. Existing data on cardiac structure and function in HFpEF suggests significant heterogeneity in this population. Echocardiograms were obtained from 935 patients with HFpEF (left ventricular ejection fraction [LVEF] ≥45%) enrolled in the Treatment Of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial prior to initiation of randomized therapy. Average age was 70±10 years, 49% were female, 14% were of African descent, and co-morbidities were highly prevalent. Centralized quantitative analysis in a blinded core laboratory demonstrated a mean LVEF of 59.3±7.9%, with prevalent concentric LV remodeling (34%) and hypertrophy (43%), and left atrial (LA) enlargement (53%). Diastolic dysfunction was present in 66% of gradable participants, and was significantly associated with greater LV hypertrophy and a higher prevalence of LA enlargement. Doppler evidence of pulmonary hypertension was present in 36%. At least 1 measure of structural heart disease was present in 93% of patients. Participants enrolled in TOPCAT demonstrated heterogeneous patterns of ventricular remodeling, with high prevalence of structural heart disease, including LV hypertrophy and LA 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. Clinicaltrials.gov Identifier NCT00094302