Servicio de Cardiología, Hospital Clínico Universitario, Universitat de Valencia, Avda. Blasco Ibáñez 17, 46010 Valencia, Spain.
Eur J Heart Fail. 2010 Jan;12(1):38-44. doi: 10.1093/eurjhf/hfp176.
To evaluate the relationship between systolic blood pressure (SBP) and long-term mortality in patients with acute heart failure (AHF) stratified by ejection fraction (LVEF): reduced (< or =40%) vs. preserved (> or =50%).
We studied 1049 consecutive patients admitted with AHF. Systolic blood pressure was determined in the emergency department. Left-ventricular ejection fraction was categorized as < or =40% (n = 288), 41-49% (n = 174), or > or =50% (n = 587). Cox regression analysis was used for multivariable analysis. Mean age and SBP were 73 +/- 11 years and 150 +/- 36 mmHg, respectively. During a median follow-up of 18 months, 290 deaths (33.1%) were identified. Higher SBP was associated with lower mortality. In multivariable analysis, a differential effect of SBP across LVEF status was documented (P-value for interaction = 0.036). In linear models, SBP was shown to be inversely related with mortality in both groups (per 10 mmHg decrease): HR((LVEF > or = 50%)): 1.06, CI 95% = 1.01-1.11; P = 0.016, and HR((LVEF < or = 40%)): 1.16, 95% CI = 1.08-1.25; P < 0.001). When SBP was modelled with restrictive cubic splines, an inverse and almost linear relationship with mortality was shown in patients with LVEF < or =40% (P < 0.001), whereas in patients with LVEF > or =50%, SBP followed a J-shape curve.
In patients with AHF, SBP showed a differential prognostic effect on mortality according to LVEF status; when LVEF was < or =40%, SBP was linearly and inversely associated with mortality. Conversely, in patients with LVEF > or =50% this relationship showed a J-shape pattern.
评估射血分数（LVEF）分层的急性心力衰竭（AHF）患者收缩压（SBP）与长期死亡率之间的关系：降低（≤40％）与保留（≥50％）。
我们研究了 1049 例连续因 AHF 入院的患者。在急诊室确定收缩压。左心室射血分数分为<或=40％（n=288），41-49％（n=174）或≥50％（n=587）。使用 Cox 回归分析进行多变量分析。平均年龄和 SBP 分别为 73±11 岁和 150±36mmHg。在中位数为 18 个月的随访期间，确定了 290 例死亡（33.1％）。较高的 SBP 与较低的死亡率相关。在多变量分析中，记录了 LVEF 状态下 SBP 的差异作用（交互 P 值=0.036）。在线性模型中，在两组中 SBP 均与死亡率呈负相关（每降低 10mmHg）：HR（LVEF≥50％）：1.06，95％CI=1.01-1.11；P=0.016，和 HR（LVEF≤40％）：1.16，95％CI=1.08-1.25；P<0.001）。当 SBP 用限制性立方样条建模时，在 LVEF≤40％的患者中显示出与死亡率呈反向且近乎线性的关系（P<0.001），而在 LVEF≥50％的患者中，SBP 呈 J 形曲线。
在 AHF 患者中，SBP 根据 LVEF 状态对死亡率具有不同的预后作用；当 LVEF≤40％时，SBP 与死亡率呈线性反比关系。相反，在 LVEF≥50％的患者中，这种关系呈 J 形模式。
