Institute of Vascular Medicine and Division of Cardiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Shatin, N.T., Hong Kong.
Eur J Heart Fail. 2012 Jan;14(1):39-44. doi: 10.1093/eurjhf/hfr154. Epub 2011 Dec 7.
Low serum albumin is common in patients with systolic heart failure and is associated with increased mortality. However, the relationship between albumin and outcome in patients with heart failure and preserved ejection fraction (HFPEF) is not known. The aim of this study was to investigate the effect of serum albumin level on survival in patients with HFPEF.
We studied 576 consecutive HFPEF patients (left ventricular ejection fraction ≥50%) admitted to our hospital from 2006 to 2009. Standard demographics, transthoracic echocardiography, and routine blood testing including albumin levels were obtained shortly after admission. Outcome was assessed at 1 year after admission. Hypoalbuminaemia (≤34 g/L) was detected in 160 (28%) at admission; and all patients were then divided into hypoalbuminaemia and non-hypoalbuminaemia groups. In the hypoalbuminaemia group, the prevalence of chronic renal failure history, serum creatinine, and urea nitrogen levels were higher when compared with those without hypoalbuminaemia (all P < 0.05). Kaplan-Meier analysis showed that patients with hypoalbuminaemia had a significantly lower survival rate (53% vs. 84%, log-rank χ(2) = 53.3, P < 0.001) and a higher rate of cardiovascular death (21.8% vs. 8.9%, log-rank χ(2) = 19.7, P < 0.001) when compared with those without hypoalbuminaemia. Cox regression further revealed that hypoalbuminaemia, a history of cerebrovascular disease, and older age were the most powerful independent predictors of all-cause mortality in HFPEF patients at 1 year.
Hypoalbuminaemia is common in HFPEF patients and is associated with increased risk of death. Renal dysfunction may be the main pathophysiological mechanism underlying hypoalbuminaemia in HFPEF patients.
血清白蛋白水平降低在收缩性心力衰竭患者中较为常见，且与死亡率升高相关。然而，心力衰竭伴射血分数保留（HFPEF）患者的白蛋白与预后之间的关系尚不清楚。本研究旨在探讨血清白蛋白水平对 HFPEF 患者生存的影响。
我们研究了 2006 年至 2009 年期间我院收治的 576 例连续 HFPEF 患者（左心室射血分数≥50%）。入院后不久即获取标准人口统计学、经胸超声心动图和包括白蛋白水平在内的常规血液检测结果。在入院后 1 年评估预后。入院时检测到低白蛋白血症（≤34 g/L）160 例（28%）；然后所有患者均被分为低白蛋白血症和非低白蛋白血症组。在低白蛋白血症组中，与无低白蛋白血症者相比，慢性肾衰竭病史、血清肌酐和尿素氮水平的发生率更高（均 P<0.05）。Kaplan-Meier 分析显示，与无低白蛋白血症者相比，低白蛋白血症患者的生存率显著较低（53% vs. 84%，log-rank χ(2)=53.3，P<0.001），心血管死亡发生率更高（21.8% vs. 8.9%，log-rank χ(2)=19.7，P<0.001）。Cox 回归进一步表明，低白蛋白血症、脑血管病史和年龄较大是 HFPEF 患者 1 年全因死亡率的最强独立预测因素。
低白蛋白血症在 HFPEF 患者中较为常见，且与死亡风险增加相关。肾功能障碍可能是 HFPEF 患者低白蛋白血症的主要病理生理机制。
