Sudden Death in Heart Failure With Preserved Ejection Fraction A Competing Risks Analysis From the TOPCAT Trial

被引：64

作者：

Vaduganathan, Muthiah ^{[1
]}

Claggett, Brian L. ^{[1
]}

Chatterjee, Neal A. ^{[2
]}

Anand, Inder S. ^{[3
,4
]}

Sweitzer, Nancy K. ^{[5
]}

Fang, James C. ^{[6
]}

O'Meara, Eileen ^{[7
,8
]}

Shah, Sanjiv J. ^{[9
]}

Hegde, Sheila M. ^{[1
]}

Desai, Akshay S. ^{[1
]}

Lewis, Eldrin F. ^{[1
]}

Rouleau, Jean ^{[7
,8
]}

Pitt, Bertram ^{[10
]}

Pfeffer, Marc A. ^{[1
]}

Solomon, Scott D. ^{[1
]}

机构：

[1] Brigham & Womens Hosp, 75 Francis St, Boston, MA 02115 USA

[2] Massachusetts Gen Hosp, Boston, MA 02114 USA

[3] VA Med Ctr, Minneapolis, MN USA

[4] Univ Minnesota, Minneapolis, MN USA

[5] Univ Arizona, Tucson, AZ USA

[6] Univ Utah, Salt Lake City, UT USA

[7] Montreal Heart Inst, Montreal, PQ, Canada

[8] Univ Montreal, Montreal, PQ, Canada

[9] Northwestern Univ, Chicago, IL 60611 USA

[10] Univ Michigan, Sch Med, Ann Arbor, MI USA

来源：

JACC-HEART FAILURE | 2018年 / 6卷 / 08期

基金：

美国国家卫生研究院;

关键词：

heart failure with preserved ejection fraction; risk prediction; sudden death; LEFT-VENTRICULAR DYSFUNCTION; CAUSE-SPECIFIC MORTALITY; IN-BED SYNDROME; CARDIAC DEATH; ALDOSTERONE ANTAGONIST; MYOCARDIAL-INFARCTION; DIASTOLIC DYSFUNCTION; OUTCOMES; ASSOCIATION; DESIGN;

D O I：

10.1016/j.jchf.2018.02.014

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

OBJECTIVES This study investigated the rates and predictors of SD or aborted cardiac arrest (ACA) in HFpEF. BACKGROUND Sudden death (SD) may be an important mode of death in heart failure with preserved ejection fraction (HFpEF). METHODS We studied 1,767 patients with HFpEF (EF >= 45%) enrolled in the Americas region of the TOPCAT (Aldosterone Antagonist Therapy for Adults With Heart Failure and Preserved Systolic Function) trial. We identified independent predictors of composite SD/ACA with stepwise backward selection using competing risks regression analysis that accounted for nonsudden causes of death. RESULTS During a median 3.0-year (25th to 75th percentile: 1.9 to 4.4 years) follow-up, 77 patients experienced SD/ACA, and 312 experienced non-SD/ACA. Corresponding incidence rates were 1.4 events/100 patient-years (25th to 75th percentile: 1.1 to 1.8 events/100 patient-years) and 5.8 events/100 patient-years (25th to 75th percentile: 5.1 to 6.4 events/100 patient-years). SD/ACA was numerically lower but not statistically reduced in those randomized to spironolactone: 1.2 events/100 patient-years (25th to 75th percentile: 0.9 to 1.7 events/100 patient-years) versus 1.6 events/100 patient-years (25th to 75th percentile: 1.2 to 2.2 events/100 patient-years); the subdistributional hazard ratio was 0.74 (95% confidence interval: 0.47 to 1.16; p = 0.19). After accounting for competing risks of non-SD/ACA, male sex and insulin-treated diabetes mellitus were independently predictive of composite SD/ACA (C-statistic = 0.65). Covariates, including eligibility criteria, age, ejection fraction, coronary artery disease, left bundle branch block, and baseline therapies, were not independently associated with SD/ACA. Sex and diabetes mellitus status remained independent predictors in sensitivity analyses, excluding patients with implantable cardioverter-defibrillators and when predicting SD alone. CONCLUSIONS SD accounted for similar to 20% of deaths in HFpEF. Male sex and insulin-treated diabetes mellitus identified patients at higher risk for SD/ACA with modest discrimination. These data might guide future SD preventative efforts in HFpEF. (Aldosterone Antagonist Therapy for Adults With Heart Failure and Preserved Systolic Function [TOPCAT]); NCT00094302 (C) 2018 by the American College of Cardiology Foundation.

引用

页码：653 / 661

页数：9

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