Ahmed Ali, Zile Michael R, Rich Michael W, Fleg Jerome L, Adams Kirkwood F, Love Thomas E, Young James B, Aronow Wilbert S, Kitzman Dalane W, Gheorghiade Mihai, Dell'Italia Louis J
University of Alabama at Birmingham, Alabama, USA.
Am J Cardiol. 2007 Feb 15;99(4):460-4. doi: 10.1016/j.amjcard.2006.08.056. Epub 2006 Dec 21.
Patients with diastolic heart failure (HF), i.e., clinical HF with normal or near normal left ventricular ejection fraction (LVEF), may develop unstable angina pectoris (UAP) due to epicardial atherosclerotic coronary artery disease and/or to subendocardial ischemia, even in the absence of coronary artery disease. However, the risk of UAP in ambulatory patients with diastolic HF has not been well studied. We examined incident hospitalizations due to UAP in 916 patients with diastolic HF (LVEF >45%) without significant valvular heart disease and 6,800 patients with systolic HF (LVEF <or=45%) in the Digitalis Investigation Group trial. During a 38-month median follow-up, 12% of patients (797 of 6,800) with systolic HF (incidence rate 435 per 10,000 person-years) and 15% of patients (138 of 916) with diastolic HF (incidence rate 536 per 10,000 person-years) were hospitalized for UAP (adjusted hazard ratio for diastolic HF 1.22, 95% confidence interval [CI] 1.02 to 1.47, p = 0.032). There was a graded increase in incident hospital admissions for UAP with increasing LVEF. Hospitalizations for UAP occurred in 11% (520 of 4,808, incidence rate 407 per 10,000 person-years), 14% (355 of 2,556, incidence rate 496 per 10,000 person-years), and 17% (60 of 352, incidence rate 613 per 10,000 person-years) of patients with HF, respectively, with LVEF values <35%, 35% to 55%, and >55%. Compared with patients with HF and an LVEF <35%, the adjusted hazard ratios for UAP hospitalization in those with LVEF values 35% to 55% and >55% were, respectively, 1.17 (95% CI 1.02 to 1.34, p = 0.028) and 1.57 (95% CI 1.20 to 2.07, p = 0.026). In conclusion, in ambulatory patients with chronic HF, a higher LVEF was associated with increased risk of hospitalizations due to UAP. As in patients with systolic HF, those with diastolic HF should be routinely evaluated for myocardial ischemia and managed accordingly.
舒张性心力衰竭（HF）患者，即左心室射血分数（LVEF）正常或接近正常的临床HF患者，即使在没有冠状动脉疾病的情况下，也可能因心外膜动脉粥样硬化性冠状动脉疾病和/或心内膜下缺血而发生不稳定型心绞痛（UAP）。然而，门诊舒张性HF患者发生UAP的风险尚未得到充分研究。我们在洋地黄研究组试验中，对916例无严重瓣膜性心脏病的舒张性HF患者（LVEF>45%）和6800例收缩性HF患者（LVEF≤45%）因UAP导致的住院情况进行了检查。在38个月的中位随访期内，收缩性HF患者中有12%（6800例中的797例，发病率为每10000人年435例），舒张性HF患者中有15%（916例中的138例，发病率为每10000人年536例）因UAP住院（舒张性HF的调整后风险比为1.22，95%置信区间[CI]为1.02至
