Núñez Julio, Mainar Luis, Bodí Vicent, Sanchis Juan, Núñez Eduardo, Miñana Gema, Husser Oliver, Bosch María José, Chorro Francisco J, Llàcer Angel
Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Universitat de València, Valencia, España.
Med Clin (Barc). 2008 Jul 5;131(5):161-6. doi: 10.1157/13124260.
The relation between left ventricular ejection fraction (LVEF) and prognosis in patients with heart failure is controversial. The aim of this study was to determine the relation of LVEF in long-term mortality and readmissions for acute heart failure in a non-selected population of patients admitted with acute heart failure (AHF).
We included 507 patients admitted consecutively for AHF in a cardiology department of a single-centre. LVEF was assessed with transthoracic echocardiography during hospitalization. All-cause mortality and readmission for AHF were selected as primary and secondary endpoints, respectively. The independent association between LVEF and endpoints was assessed with traditional Cox regression analysis for all-cause mortality and Cox regression for competing risks for readmission for AHF.
47% of patients exhibited LVEF > or = 50%. During a median follow-up of one year, 151 (30%) deaths and 139 (27%) readmissions for AHF were observed. Mortality rates were higher in patients with LVEF < 50% (34 vs 25%; p = 0.028) and no differences were observed for readmissions for AHF (26 vs 29%, p = 0.510). In multivariate analysis, after adjustment for traditional risk factors, patients with LVEF < 50% did not show higher risk of mortality (hazard ratio [HR] = 1.08; 95% confidence interval [CI], 0.76-1.57; p = 0.645) or readmissions for AHF (HR = 1.00; 95% CI, 0.68-1.47; p = 1).
Patients with preserved LVEF constitute a substantial proportion of patients with AHF, exhibiting similar mortality and readmissions risks compared with patients with depressed LVEF.
心力衰竭患者的左心室射血分数（LVEF）与预后之间的关系存在争议。本研究的目的是确定在因急性心力衰竭（AHF）入院的非选择性患者群体中，LVEF与长期死亡率及急性心力衰竭再入院之间的关系。
我们纳入了单中心心内科连续收治的507例AHF患者。住院期间采用经胸超声心动图评估LVEF。全因死亡率和AHF再入院分别作为主要和次要终点。采用传统Cox回归分析评估LVEF与全因死亡率终点之间的独立关联，采用竞争风险Cox回归评估LVEF与AHF再入院终点之间的独立关联。
47%的患者LVEF≥50%。在中位随访1年期间，观察到151例（30%）死亡和139例（27%）AHF再入院。LVEF<50%的患者死亡率较高（34%对25%；p = 0.028），而AHF再入院率无差异（26%对29%，p = 0.510）。在多变量分析中，在对传统危险因素进行校正后，LVEF<50%的患者未显示出更高的死亡风险（风险比[HR]=1.08；95%置信区间[CI]，0.76 - 1.57；p = 0.645）或AHF再入院风险（HR = 1.00；95%CI，0.68 - 1.47；p = 1）。
LVEF保留的患者占AHF患者的很大比例，与LVEF降低的患者相比，其死亡率和再入院风险相似。
