Ammar Khawaja Afzal, Jacobsen Steven J, Mahoney Douglas W, Kors Jan A, Redfield Margaret M, Burnett John C, Rodeheffer Richard J
Division of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
Circulation. 2007 Mar 27;115(12):1563-70. doi: 10.1161/CIRCULATIONAHA.106.666818. Epub 2007 Mar 12.
Heart failure (HF) is a progressive disorder associated with frequent morbidity and mortality. An American Heart Association/American College of Cardiology staging classification of HF has been developed to emphasize early detection and prevention. The prevalence of HF stages and their association with mortality are unknown. We sought to estimate HF stage prevalence in the community and to measure the association of HF stages with mortality.
A population-based, cross-sectional, random sample of 2029 Olmsted County, Minnesota, residents aged > or = 45 years was identified. Participants were classified by medical record review, symptom questionnaire, physical examination, and echocardiogram as follows: stage 0, healthy; stage A, HF risk factors; stage B, asymptomatic cardiac structural or functional abnormalities; stage C, HF symptoms; and stage D, severe HF. In the cohort, 32% were stage 0, 22% stage A, 34% stage B, 12% stage C, and 0.2% stage D. Mean B-type natriuretic peptide concentrations (in pg/mL) increased by stages: stage 0=26, stage A=32, stage B=53, stage C=137, and stage D=353. Survival at 5 years was 99% in stage 0, 97% in stage A, 96% in stage B, 75% in stage C, and 20% in stage D.
The present study provides prevalence estimates and prognostic validation for HF staging in a community cohort. Of note, 56% of adults > or = 45 years of age were classified as being in stage A (risk factors) or B (asymptomatic ventricular dysfunction). HF staging underscores the magnitude of the population at risk for progression to overt HF.
心力衰竭（HF）是一种与高发病率和死亡率相关的进行性疾病。美国心脏协会/美国心脏病学会已制定了心力衰竭的分期分类，以强调早期检测和预防。心力衰竭各阶段的患病率及其与死亡率的关联尚不清楚。我们旨在估计社区中心力衰竭各阶段的患病率，并衡量心力衰竭各阶段与死亡率的关联。
确定了明尼苏达州奥姆斯特德县2029名年龄≥45岁居民的基于人群的横断面随机样本。通过病历审查、症状问卷、体格检查和超声心动图将参与者分类如下：0期，健康；A期，心力衰竭危险因素；B期，无症状性心脏结构或功能异常；C期，心力衰竭症状；D期，严重心力衰竭。在该队列中，32%为0期，22%为A期，34%为B期，12%为C期，0.2%为D期。B型利钠肽平均浓度（单位：pg/mL）随阶段升高：0期=26，A期=32，B期=53，C期=137，D期=353。0期5年生存率为99%，A期为97%，B期为96%，C期为75%，D期为20%。
本研究为社区队列中的心力衰竭分期提供了患病率估计和预后验证。值得注意的是，56%年龄≥45岁的成年人被分类为处于A期（危险因素）或B期（无症状性心室功能障碍）。心力衰竭分期强调了有进展为明显心力衰竭风险的人群规模。
