Bursi Francesca, Weston Susan A, Redfield Margaret M, Jacobsen Steven J, Pakhomov Serguei, Nkomo Vuyisile T, Meverden Ryan A, Roger Véronique L
Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic and Foundation, Rochester, Minn 55905, USA.
JAMA. 2006 Nov 8;296(18):2209-16. doi: 10.1001/jama.296.18.2209.
The heart failure (HF) syndrome is heterogeneous. While it can be defined by ejection fraction (EF) and diastolic function, data on the characteristics of HF in the community are scarce, as most studies are retrospective, hospital-based, and rely on clinically indicated tests. Further, diastolic function is seldom systematically assessed based on standardized techniques.
To prospectively measure EF, diastolic function, and brain natriuretic peptide (BNP) in community residents with HF.
Echocardiographic measures of EF and diastolic function, measurement of blood levels of BNP, and 6-month mortality.
DESIGN, SETTING, AND PARTICIPANTS: Olmsted County residents with incident or prevalent HF (inpatients or outpatients) between September 10, 2003, and October 27, 2005, were prospectively recruited to undergo assessment of EF and diastolic function by echocardiography and measurement of BNP.
A total of 556 study participants underwent echocardiography at HF diagnosis. Preserved EF (> or =50%) was present in 308 (55%) and was associated with older age, female sex, and no history of myocardial infarction (all P<.001). Isolated diastolic dysfunction (diastolic dysfunction with preserved EF) was present in 242 (44%) patients. For patients with reduced EF, moderate or severe diastolic dysfunction was more common than when EF was preserved (odds ratio, 1.67; 95% confidence interval [CI], 1.11-2.51; P = .01). Both low EF and diastolic dysfunction were independently related to higher levels of BNP. At 6 months, mortality was 16% for both preserved and reduced EF (age- and sex-adjusted hazard ratio, 0.85; 95% CI, 0.61-1.19; P = .33 for preserved vs reduced EF).
In the community, more than half of patients with HF have preserved EF, and isolated diastolic dysfunction is present in more than 40% of cases. Ejection fraction and diastolic dysfunction are independently related to higher levels of BNP. Heart failure with preserved EF is associated with a high mortality rate, comparable to that of patients with reduced EF.
心力衰竭（HF）综合征具有异质性。虽然它可以通过射血分数（EF）和舒张功能来定义，但关于社区中HF特征的数据却很稀少，因为大多数研究都是回顾性的、基于医院的，并且依赖于临床指示的检查。此外，舒张功能很少基于标准化技术进行系统评估。
前瞻性测量社区HF居民的EF、舒张功能和脑钠肽（BNP）。
EF和舒张功能的超声心动图测量、BNP血水平测量以及6个月死亡率。
设计、地点和参与者：前瞻性招募了2003年9月10日至2005年10月27日期间奥姆斯特德县患有新发或现患HF的居民（住院患者或门诊患者），以通过超声心动图评估EF和舒张功能并测量BNP。
共有556名研究参与者在HF诊断时接受了超声心动图检查。308名（55%）患者存在保留EF（≥50%），且与年龄较大、女性以及无心肌梗死病史相关（所有P<0.001）。242名（44%）患者存在孤立性舒张功能障碍（EF保留时的舒张功能障碍）。对于EF降低的患者，中度或重度舒张功能障碍比EF保留时更常见（比值比，1.67；95%置信区间[CI]，1.11 - 2.51；P = 0.01）。低EF和舒张功能障碍均与较高的BNP水平独立相关。在6个月时，保留EF和降低EF的患者死亡率均为16%（年龄和性别调整后的风险比，0.85；95%CI，0.61 - 1.19；保留EF与降低EF相比，P = 0.33）。
在社区中，超过一半的HF患者EF保留，超过40%的病例存在孤立性舒张功能障碍。EF和舒张功能障碍与较高的BNP水平独立相关。EF保留的心力衰竭与较高的死亡率相关，与EF降低的患者相当。
