Role of Ischemic Heart Disease in Major Adverse Renal and Cardiac Events Among Individuals with Heart Failure with Preserved Ejection Fraction (From the TOPCAT Trial).
Despite improvements in the prognosis of patients with heart failure with reduced ejection fraction (HFrEF), established therapy for heart failure patients with preserved ejection fraction (HFpEF) is lacking. Additionally, ischemic heart disease adversely impacts the clinical course of HFrEF patients; however, its role in HFpEF is not fully understood. We conducted a post hoc analysis of propensity score matched patients from the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial to compare HFpEF patients with versus without myocardial ischemia in terms of major adverse renal and/or cardiac events (MARCE). Of 3445 participants, the prevalence of ischemia was 59%. For this analysis, we included 1747 ischemic patients and 1207 propensity matched non-ischemic patients. Ischemia was associated with a 20% increased risk (HR=1.20, 95% CI=1.042-1.382, p-value=0.0112) of MARCE in adjusted analyses. Other important predictors of MARCE were diabetes (HR=1.60, 95% CI=1.38-1.87, p <0.0001), dyslipidemia (HR=1.30, 95% CI=1.10-1.52, p=0.001) and smoking (HR=1.33, 95% CI=1.04-1.69, p= 0.0197). Revascularization was not significantly associated with MARCE in the subgroup of ischemic HFpEF patients. Future work is warranted to develop tailored interventions for patients with both HFpEF and ischemic heart disease to mitigate the risk of MARCE .