Chen Horng H, Lainchbury John G, Senni Michele, Bailey Kent R, Redfield Margaret M
Division of Cardiovascular Diseases and the Department of Health Sciences Research, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA.
J Card Fail. 2002 Oct;8(5):279-87. doi: 10.1054/jcaf.2002.128871.
Diastolic heart failure (DHF) has been broadly defined as "signs and symptoms of congestive heart failure (CHF) with normal/near normal systolic function." The clinical profile and natural history of the syndrome remain controversial. Furthermore, the frequency with which patients with CHF and normal ejection fraction (EF) fulfill recently proposed standardized diagnostic criteria for DHF is unclear. Our objective was to determine the clinical profile, Doppler echocardiographic features, current management, prognosis, and predictors of outcome of all patients with new onset CHF who had normal EF in Olmsted County, Minnesota, during 1996-1997. The frequency with which patients met recently proposed standardized criteria for diagnosis of DHF was assessed.
Using the resources of the Rochester Epidemiology Project, all residents of Olmsted County, Minnesota, with a new diagnosis of CHF in 1996-1997, an ejection fraction >45%, and no valve disease (n = 83) were identified.
Patients were elderly (79 +/- 13 yr), predominantly female (76%), and had hypertension and/or coronary artery disease (85%). New-onset atrial fibrillation, ischemia, and medical comorbidities were frequently present at diagnosis. Although most patients (81%) met criteria for "probable DHF" by recently proposed clinical criteria, only half of patients met European criteria in which evidence of abnormal function/filling is required. The 1-, 2-, and 3-year mortality rates were 29%, 39%, and 60%, respectively. Angiotensin-converting enzyme inhibition (P =.0008) and beta-blocker (P =.02) therapy were independently associated with improved survival.
This population-based study provides a comprehensive clinical profile, current management, prognosis, and predictors of outcome of patients with new onset CHF who had normal ejection fraction.
舒张性心力衰竭（DHF）被广泛定义为“收缩功能正常/接近正常的充血性心力衰竭（CHF）的体征和症状”。该综合征的临床特征和自然病史仍存在争议。此外，CHF且射血分数（EF）正常的患者符合最近提出的DHF标准化诊断标准的频率尚不清楚。我们的目的是确定1996 - 1997年明尼苏达州奥尔姆斯特德县所有新发CHF且EF正常的患者的临床特征、多普勒超声心动图特征、当前治疗、预后及结局预测因素。评估了患者符合最近提出的DHF诊断标准化标准的频率。
利用罗切斯特流行病学项目的资源，确定了明尼苏达州奥尔姆斯特德县1996 - 1997年新诊断为CHF、射血分数>45%且无瓣膜病的所有居民（n = 83）。
患者年龄较大（79±13岁），女性占主导（76%），患有高血压和/或冠状动脉疾病（85%）。诊断时经常出现新发房颤、缺血和合并症。尽管根据最近提出的临床标准，大多数患者（81%）符合“可能的DHF”标准，但只有一半患者符合需要功能/充盈异常证据的欧洲标准。1年、2年和3年死亡率分别为29%、39%和60%。血管紧张素转换酶抑制剂治疗（P = 0.0008）和β受体阻滞剂治疗（P = 0.02）与生存率提高独立相关。
这项基于人群的研究提供了新发CHF且射血分数正常的患者的全面临床特征、当前治疗、预后及结局预测因素。
