Cited by 478Cardiovascular Function and Risk FactorsHeart Failure Treatment and ManagementCardiac pacing and defibrillation studies

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Prognostic Importance of Impaired Systolic Function in Heart Failure With Preserved Ejection Fraction and the Impact of Spironolactone

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Shah, Amil M., Claggett, Brian, Sweitzer, Nancy K., Shah, Sanjiv J., Anand, Inder S., Liu, Li, Pitt, Bertram, Pfeffer, Marc A., Solomon, Scott D.·2015·Circulation

DOI 10.1161/circulationaha.115.015884PMC PMC4526442

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Abstract

Background—: Impairment in left ventricular systolic function has been described in heart failure (HF) with preserved ejection fraction (HFpEF), but its prognostic relevance is not known. We determined whether left ventricular longitudinal strain (LS) is predictive of cardiovascular outcomes in HFpEF beyond clinical and conventional echocardiographic measures. Methods and Results—: LS was assessed by 2-dimensional speckle-tracking echocardiography at baseline in 447 patients with HFpEF enrolled in the Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist (TOPCAT) trial. At a median follow-up of 2.6 years (interquartile range, 1.5–3.9 years), 115 patients experienced the primary composite outcome of cardiovascular death, HF hospitalization, or aborted cardiac arrest. Impaired LS, defined as an absolute LS <15.8%, was present in 52% of patients and was predictive of the composite outcome (adjusted hazard ratio, 2.14; 95% confidence interval, 1.26–3.66; P =0.005), cardiovascular death alone (adjusted hazard ratio, 3.20; 95% confidence interval, 1.44–7.12; P =0.004), and HF hospitalization alone (adjusted hazard ratio, 2.23; 95% confidence interval, 1.16–4.28; P =0.016) after adjustment for clinical and conventional echocardiographic variables. LS was the strongest echocardiographic predictor of the composite outcome. Exploratory analysis in a subset of 131 patients with follow-up LS assessed after 12 to 18 months demonstrated a trend toward improvement in LS associated with spironolactone in patients enrolled in the Americas but not in Russia or Georgia. Conclusions—: Impaired left ventricular systolic function is a powerful predictor of HF hospitalization, cardiovascular death, or aborted cardiac arrest in HFpEF independent of clinical predictors. Impaired LS represents a novel imaging biomarker to identify patients with HFpEF at particularly high risk for cardiovascular morbidity and mortality. Clinical Trial Registration—: URL: http://www.clinicaltrials.gov . Unique identifier: NCT00094302.

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Authors: Shah, A. M., Claggett, B., Sweitzer, N. K., Shah, S. J., Anand, I. S., Liu, L., Pitt, B., Pfeffer, M. A., & Solomon, S. D.
Affiliations: Northwestern University (US)
ORCID: Shah, Amil M.
Claggett, Brian
Sweitzer, Nancy K.
Shah, Sanjiv J.
Anand, Inder S.
Liu, Li
Pitt, Bertram
Pfeffer, Marc A.
Solomon, Scott D.
Venue: Circulation
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2015-08-04
Volume: 132
Issue: 5
Pages: 402-414
ISSN: 0009-7322 (ISSN-L)
1524-4539
DOI: 10.1161/circulationaha.115.015884
PMC: PMC4526442
OpenAlex: W2105400632
Cited by: 478
References: 60
Citations by year: 2026: 14 · 2025: 33 · 2024: 36 · 2023: 45 · 2022: 63 · 2021: 52 · 2020: 59 · 2019: 47 · 2018: 37 · 2017: 41 · 2016: 39 · 2015: 9
FWCI: 30.57
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: Circulation (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Funders: U.S. Department of Health and Human Services (HHSN268201100007C, HHSN268201100012C, HHSN268201100005C, HHSN268201100008C, HHSN268201100006C, HHSN268201100010C, HHSN268201100011C, HHSN268201100009C)
American Heart Association (HHSN268201100006C, HHSN268201100007C, HHSN268201100008C, 14CRP20380422, HHSN268201100012C, HHSN268201100005C, HHSN268201100009C, HHSN268201100011C, HHSN268201100010C)
National Heart, Lung, and Blood Institute (HHSN268201 100012C, HHSN268201100007I, HHSN268201100007C, HHSN2682 01100008C, HH-SN-268201100006C, HHSN268201100011C, HHSN2682011-00005I, HHSN2682011-00009I, HHSN268201100005C, HHSN268201100005G, HHSN268201100010C, HHSN268201100011I, HHSN26820 1100009C, K08HL116792, HHSN2682011-00008I, HHSN268200425207C)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
Keywords: heart failure with preserved ejection fraction, left ventricular systolic function, left ventricular longitudinal strain, spironolactone, prognosis, cardiovascular mortality, heart failure hospitalization, speckle tracking echocardiography, imaging biomarkers, TOPCAT trial, mineralocorticoid receptor antagonists
MeSH terms: Aged, Aged, 80 and over, Mineralocorticoid Receptor Antagonists, Double-Blind Method, Electrocardiography, Female, Follow-Up Studies, Heart Arrest, Hospitalization, Humans, Male, Middle Aged, Prognosis, Spironolactone, Stroke Volume, Incidence, Survival Rate, Treatment Outcome, Ventricular Dysfunction, Left, Internationality, Heart Failure, Systolic

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Prognostic Importance of Impaired Systolic Function in Heart Failure With Preserved Ejection Fraction and the Impact of Spironolactone

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