Cardiac Function and Sudden Cardiac Death in Heart Failure With Preserved Ejection Fraction (from the TOPCAT Trial)

Area of Science:

• Cardiology
• Medical Imaging
• Heart Failure Research

Background:

• Patients with heart failure with preserved ejection fraction (HFpEF) face a high risk of sudden cardiac death (SCD).
• Limited echocardiographic data currently correlate with this elevated SCD risk in HFpEF.
• Predictive imaging markers for SCD in HFpEF remain an area of active investigation.

Purpose of the Study:

• To evaluate the predictive value of multiple echocardiographic markers of left ventricular (LV) function for sudden cardiac death (SCD) in patients with HFpEF.
• To identify specific echocardiographic parameters that can effectively prognosticate SCD and/or aborted cardiac arrest (SCD/ACA) in this population.

Main Methods:

• Utilized the Treatment of Heart Failure with Preserved Ejection Fraction with Aldosterone Trial (TOPCAT)-Americas cohort for a retrospective analysis.
• Assessed echocardiographic parameters including diastolic dysfunction grade, left ventricle ejection fraction, and LV global longitudinal strain (GLS).
• Employed Cox proportional hazards and Poisson regression models, including competing risk analyses, to determine associations with SCD/ACA events.

Main Results:

• Univariate analysis showed impaired left ventricle ejection fraction and GLS were associated with SCD/ACA.
• Diastolic function grade did not significantly predict SCD/ACA in univariate models.
• Multivariate analysis revealed LV global longitudinal strain (GLS) as the sole significant independent predictor of SCD/ACA incidence.

Conclusions:

• Left ventricular global longitudinal strain (GLS) emerges as a valuable echocardiographic marker for prognostication of sudden cardiac death (SCD) and/or aborted cardiac arrest (SCD/ACA) in HFpEF patients.
• GLS provides incremental prognostic information beyond traditional measures in this high-risk cohort.
• Further research may integrate GLS into clinical risk stratification tools for HFpEF.