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

Kalra, Rajat; Gupta, Kartik; Sheets, Ryan; Aryal, Sudeep; Ebrahimi, Ali; Rajapreyar, Indranee; Cribbs, Marc; Booker, Oscar Julian; Prabhu, Sumanth D.; Bajaj, Navkaranbir

doi:10.1016/j.amjcard.2020.04.038

Cited by 10 publications

(8 citation statements)

References 28 publications

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“…In predicting cardiac arrest among specific populations, impaired left ventricular ejection fraction and left ventricular global longitudinal strain were both associated with an increased risk of sudden cardiac death 9,10 . Specifically, global longitudinal strain was most predictive and had an increased hazard ratio of 58% with each increasing unit of strain 9 .…”

Section: Resultsmentioning

confidence: 99%

“…9,10 Specifically, global longitudinal strain was most predictive and had an increased hazard ratio of 58% with each increasing unit of strain. 9 In a validation of existing predictive models developed with Western patients, a study of Chinese patients with hypertrophic cardiomyopathy found the 2019 combined American College of Cardiology/American Heart Association model to have a positive predictive value of 66% for cardiac arrest during the observational period compared to other guidelines. 10…”

Section: Epidemiology and Public Health Initiativesmentioning

confidence: 99%

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Cardiac arrest: An interdisciplinary scoping review of clinical literature from 2020

et al. 2022

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Section: Resultsmentioning

confidence: 99%

Section: Epidemiology and Public Health Initiativesmentioning

confidence: 99%

Cardiac arrest: An interdisciplinary scoping review of clinical literature from 2020

et al. 2022

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“…These findings of the present study seem to be opposite to the relationship between SCD and Hb levels in a recent report from the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist) trial. 24 The main difference from this previous study was that we used a novel methodology to identify anaemia as an independent factor associated with an increased 'proportional' SCD or non-SCD risk rather than with the 'absolute' risk of SCD. Notably, the prevalence of HF patients with anaemia in Asia has been reported to be higher than that in Western countries, ranging from 57% to 61% in Japan 25 and 53% in the US registry (Acute Decompensated Heart Failure National Registry [ADHERE]).…”

Section: Discussionmentioning

confidence: 94%

Sudden cardiac death after acute decompensation in heart failure patients: implications of discharge haemoglobin levels

et al. 2021

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Aims Heart failure (HF) patients have a high risk of mortality due to sudden cardiac death (SCD) and non-SCD, including pump failure death (PFD). Anaemia predicts more severe symptomatic burden and higher morbidity, as noted by markedly increased hospitalizations and readmission rates, and mortality, underscoring its importance in HF management. Herein, we aimed to determine whether haemoglobin (Hb) level at discharge affects the mode of death and influences SCD risk prediction. Methods We evaluated the data of 3020 consecutive acute HF patients from a Japanese prospective multicentre registry. Patients were divided into four groups based on discharge Hb levels. SCD was defined as an unexpected and otherwise unexplained death in a previously stable patient or death due to documented or presumed cardiac arrhythmia without a clear non-cardiovascular cause. The mode of death (SCD, PFD or other cause) was adjudicated by a central committee. Finally, we investigated whether adding Hb level to the Seattle Proportional Risk Model (SPRM; established risk score utilized to estimate 'proportion' of SCD among death events) would affect its performance. Results The mean age of studied patients was 74.3 ± 12.9 years, and 59.8% were male. The mean Hb level was 12.0 ± 2.1 g/dL (61.3% of patients had anaemia defined by World Health Organization criteria). During the 2-year follow-up, 474 deaths (15.7%) occurred, including 93 SCDs (3.1%), 171 PFDs (5.7%) and 210 other deaths (7.0%; predominantly non-cardiac death). Absolute risk of PFD (P < 0.001) or other death (P < 0.001) increased along with the severity of anaemia, whereas the incidence of SCD was low but remained consistent across all four groups (P = 0.440). As a proportion of total deaths in each Hb level group, the contributions from non-SCD increased and from SCD decreased along with anaemia severity (P = 0.007). Adding Hb level to the SPRM improved the overall discrimination (c-index: 0.62 [95% confidence interval (CI) 0.56-0.69] to 0.65 [95% CI 0.59-0.71]), regardless of the baseline ejection fraction (EF) (c-index: 0.64 [95% CI 0.55-0.73] to 0.67 [95% CI 0.58-0.75] for reduced EF and 0.55 [95% CI 0.45-0.66] to 0.61 [95% CI 0.52-0.70] for preserved EF). Conclusions The discharge Hb level provides information about both absolute and proportional risks for each mode of death in acute HF patients, and the addition of Hb level improves the performance of SPRM by identifying more non-SCD cases. Future 'proportional' SCD risk models should incorporate Hb level as a covariate to meet this high performance.

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“…Risk stratification for mode-specific death has been studied in patients with HFrEF [14][15][16], but remains largely unexplored in patients with HFpEF [17][18][19][20]. Identification of prognostic factors for mode-specific death may help with the understanding of the pathophysiological mechanisms underlying the cause of death.…”

Section: Discussionmentioning

confidence: 99%

Developing and validating models to predict sudden death and pump failure death in patients with heart failure and preserved ejection fraction

et al. 2020

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Background Sudden death (SD) and pump failure death (PFD) are leading modes of death in heart failure and preserved ejection fraction (HFpEF). Risk stratification for mode-specific death may aid in patient enrichment for new device trials in HFpEF. Methods Models were derived in 4116 patients in the Irbesartan in Heart Failure with Preserved Ejection Fraction trial (I-Preserve), using competing risks regression analysis. A series of models were built in a stepwise manner, and were validated in the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM)-Preserved and Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trials. Results The clinical model for SD included older age, men, lower LVEF, higher heart rate, history of diabetes or myocardial infarction, and HF hospitalization within previous 6 months, all of which were associated with a higher SD risk. The clinical model predicting PFD included older age, men, lower LVEF or diastolic blood pressure, higher heart rate, and history of diabetes or atrial fibrillation, all for a higher PFD risk, and dyslipidaemia for a lower risk of PFD. In each model, the observed and predicted incidences were similar in each risk subgroup, suggesting good calibration. Model discrimination was good for SD and excellent for PFD with Harrell’s C of 0.71 (95% CI 0.68–0.75) and 0.78 (95% CI 0.75–0.82), respectively. Both models were robust in external validation. Adding ECG and biochemical parameters, model performance improved little in the derivation cohort but decreased in validation. Including NT-proBNP substantially increased discrimination of the SD model, and simplified the PFD model with marginal increase in discrimination. Conclusions The clinical models can predict risks for SD and PFD separately with good discrimination and calibration in HFpEF and are robust in external validation. Adding NT-proBNP further improved model performance. These models may help to identify high-risk individuals for device intervention in future trials. Clinical trial registration I-Preserve: ClinicalTrials.gov NCT00095238; TOPCAT: ClinicalTrials.gov NCT00094302; CHARM-Preserved: ClinicalTrials.gov NCT00634712. Graphic abstract

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

Cited by 10 publications

References 28 publications

Cardiac arrest: An interdisciplinary scoping review of clinical literature from 2020

Cardiac arrest: An interdisciplinary scoping review of clinical literature from 2020

Sudden cardiac death after acute decompensation in heart failure patients: implications of discharge haemoglobin levels

Developing and validating models to predict sudden death and pump failure death in patients with heart failure and preserved ejection fraction

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