Ahmed Ali, Aronow Wilbert S, Fleg Jerome L
Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Alabama, Birmingham, AL, USA.
Am Heart J. 2006 Feb;151(2):444-50. doi: 10.1016/j.ahj.2005.03.066.
The association between higher New York Heart Association (NYHA) class and outcomes in patients with heart failure and preserved systolic function is not well known.
We performed a retrospective follow-up study of 988 patients with heart failure with ejection fraction > 45% who participated in the DIG trial. Using Cox proportional hazard models, we estimated risks and all-cause mortality, heart failure mortality, all-cause hospitalization, and hospitalization due to worsening heart failure during a median follow-up of 38.5 months.
Patients had a median age of 68 years; 41.2% were women and 13.9%, nonwhites. Overall, 23.4% of patients died, and 19.9% were hospitalized because of worsening heart failure. Proportion of patients with NYHA classes I, II, III, and IV were 19.9%, 58.0%, 20.9%, and 1.2%, respectively, and 14.7%, 21.1%, 35.9%, and 58.3%, respectively, died of all causes (P < .001 for trend). Respective rates for heart failure-related hospitalizations were 14.2%, 17.1%, 32.5%, and 33.3% (P < .001 for trend). Compared with NYHA class I patients, adjusted hazard ratios (HRs) for all-cause mortality for class II, III, and IV patients were 1.54 (95% CI 1.02-2.32, P = .042), 2.56 (95% CI 1.64-24.01, P < .001), and 8.46 (95% CI 3.57-20.03, P < .001), respectively. Respective adjusted HRs (95% CI) for hospitalization due to heart failure for class II, III, and IV patients were 1.16 (0.76-1.77) (P = .502), 2.27 (1.45-3.56) (P < .001), and 3.71 (1.25-11.02) (P = 018). New York Heart Association classes II through IV were also associated with higher risk of all-cause hospitalization.
Higher NYHA classes were associated with poorer outcomes in patients with heart failure and preserved systolic function.
纽约心脏协会（NYHA）心功能分级较高与射血分数保留的心力衰竭患者的预后之间的关联尚不明确。
我们对参与DIG试验的988例射血分数>45%的心力衰竭患者进行了一项回顾性随访研究。使用Cox比例风险模型，我们在38.5个月的中位随访期内估计了全因死亡率、心力衰竭死亡率、全因住院率以及因心力衰竭恶化导致的住院率。
患者的中位年龄为68岁；41.2%为女性，13.9%为非白人。总体而言，23.4%的患者死亡，19.9%的患者因心力衰竭恶化而住院。NYHA心功能I、II、III和IV级的患者比例分别为19.9%、58.0%、20.9%和1.2%，全因死亡的患者比例分别为14.7%、21.1%、35.9%和58.3%（趋势P<.001）。心力衰竭相关住院率分别为14.2%、17.1%、32.5%和33.3%（趋势P<.001）。与NYHA心功能I级患者相比，II、III和IV级患者全因死亡的校正风险比（HR）分别为1.54（95%CI 1.02 - 2.32，P =.042）、2.56（95%CI 1.64 - 24.01，P<.001）和8.46（95%CI 3.57 - 20.03，P<.001）。II、III和IV级患者因心力衰竭住院的相应校正HR（95%CI）分别为1.16（0.76 - 1.77）（P =.502）, 2.27（1.45 - 3.56）（P<.001）和3.71（1.25 - 11.02）（P = 018）。NYHA心功能II至IV级也与全因住院风险较高相关。
NYHA心功能分级较高与射血分数保留的心力衰竭患者较差的预后相关。
