Tarantini Luigi, Faggiano Pompilio, Senni Michele, Lucci Donata, Bertoli Daniele, Porcu Maurizio, Opasich Cristina, Tavazzi Luigi, Maggioni Aldo Pietro
Department of Cardiology, San Martino Hospital, Belluno, Italy.
Ital Heart J. 2002 Nov;3(11):656-64.
BACKGROUND: The aim of this study was to evaluate the clinical characteristics, 1-year prognosis and therapeutic approach of heart failure with a preserved left ventricular systolic function in a large multicenter registry of patients referred to specialized heart failure clinics. METHODS: The study population consisted of 5164 outpatients (mean age 62 +/- 12 years, 78.8% male, 28.1% in NYHA functional class III-IV) with an available left ventricular ejection fraction (LVEF) measurement at the initial evaluation for enrollment in the Italian Network on Congestive Heart Failure. A 1-year follow-up was available for 2390 patients. RESULTS: 2859 out of 5164 patients (55.4%) had an LVEF < 35%, 1618 (31.3%) had an LVEF between 35 and 45%, and 687 patients (13.3%) had an LVEF > 45%. Patients with an LVEF > 45% were significantly older, more often female and presented a significantly higher prevalence of a hypertensive etiology, obesity and atrial fibrillation. The severity of the clinical picture, as indicated by a lower prevalence of NYHA class III-IV (17.2 vs 35.6%, p = 0.001) and a third heart sound (14.8 vs 33.5%, p = 0.001), was less in patients with an LVEF > 45%. The therapeutic approach differed significantly, with a larger use of calcium antagonists and beta-blockers in patients with an LVEF > 45%, while ACE-inhibitors, diuretics and digoxin were more often prescribed to those with an impaired LVEF. The 1-year mortality and morbidity (all cause and congestive heart failure worsening hospitalizations) were significantly lower in patients with a preserved left ventricular systolic function compared to those with left ventricular systolic dysfunction (8.9 vs 18.8% for mortality, p = 0.001, and 8.3 vs 16.5% for hospital readmissions due to worsening congestive heart failure, p = 0.001, respectively). CONCLUSIONS: Patients with congestive heart failure and a preserved left ventricular systolic function seem to constitute a distinct population not infrequently presenting even in the clinical setting of specialized heart failure clinics. Further studies are needed to establish a definitive and standardized diagnosis and the most appropriate therapy for congestive heart failure with a normal LVEF.
背景：本研究旨在评估在一个大型多中心登记研究中，转诊至专业心力衰竭诊所的左心室收缩功能保留的心力衰竭患者的临床特征、1年预后及治疗方法。 方法：研究人群包括5164例门诊患者（平均年龄62±12岁，男性占78.8%，纽约心脏协会（NYHA）心功能Ⅲ - Ⅳ级患者占28.1%），这些患者在意大利充血性心力衰竭网络初始评估登记时可获得左心室射血分数（LVEF）测量值。2390例患者有1年随访数据。 结果：5164例患者中，2859例（55.4%）LVEF<35%，1618例（31.3%）LVEF在35%至45%之间，687例（13.3%）LVEF>45%。LVEF>45%的患者年龄显著更大，女性更常见，高血压病因、肥胖和房颤的患病率显著更高。LVEF>45%的患者临床症状严重程度较低，表现为NYHAⅢ - Ⅳ级患病率较低（17.2%对35.6%，p = 0.001）和第三心音发生率较低（14.8%对33.5%，p = 0.001）。治疗方法有显著差异，LVEF>45%的患者更多使用钙拮抗剂和β受体阻滞剂，而LVEF受损的患者更常使用血管紧张素转换酶抑制剂（ACE抑制剂）、利尿剂和地高辛。与左心室收缩功能不全的患者相比，左心室收缩功能保留的患者1年死亡率和发病率（全因及充血性心力衰竭恶化住院）显著更低（死亡率8.9%对18.8%，p = 0.001；因充血性心力衰竭恶化再次住院率8.3%对16.5%，p = 0.001）。 结论：充血性心力衰竭且左心室收缩功能保留的患者似乎构成一个独特群体，即使在专业心力衰竭诊所的临床环境中也并不少见。需要进一步研究以确立明确且标准化的诊断方法以及针对LVEF正常的充血性心力衰竭的最合适治疗方案。
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