National Heart, Lung, and Blood Institute, Framingham Heart Study, MA, USA.
Eur Heart J. 2012 Jul;33(14):1734-41. doi: 10.1093/eurheartj/ehs070. Epub 2012 Apr 16.
Heart failure (HF) is a major public health burden worldwide. Of patients presenting with HF, 30-55% have a preserved ejection fraction (HFPEF) rather than a reduced ejection fraction (HFREF). Our objective was to examine discriminating clinical features in new-onset HFPEF vs. HFREF.
Of 712 participants in the Framingham Heart Study (FHS) hospitalized for new-onset HF between 1981 and 2008 (median age 81 years, 53% female), 46% had HFPEF (EF >45%) and 54% had HFREF (EF ≤45%). In multivariable logistic regression, coronary heart disease (CHD), higher heart rate, higher potassium, left bundle branch block, and ischaemic electrocardiographic changes increased the odds of HFREF; female sex and atrial fibrillation increased the odds of HFPEF. In aggregate, these clinical features predicted HF subtype with good discrimination (c-statistic 0.78). Predictors were examined in the Enhanced Feedback for Effective Cardiac Treatment (EFFECT) study. Of 4436 HF patients (median age 75 years, 47% female), 32% had HFPEF and 68% had HFREF. Distinguishing clinical features were consistent between FHS and EFFECT, with comparable discrimination in EFFECT (c-statistic 0.75). In exploratory analyses examining the traits of the intermediate EF group (EF 35-55%), CHD predisposed to a decrease in EF, whereas other clinical traits showed an overlapping spectrum between HFPEF and HFREF.
Multiple clinical characteristics at the time of initial HF presentation differed in participants with HFPEF vs. HFREF. While CHD was clearly associated with a lower EF, overlapping characteristics were observed in the middle of the left ventricular EF range spectrum.
心力衰竭（HF）是全球范围内的一个主要公共卫生负担。在出现 HF 的患者中，30-55%具有射血分数保留（HFPEF）而不是射血分数降低（HFREF）。我们的目的是检查新发 HFPEF 与 HFREF 之间的鉴别临床特征。
在 1981 年至 2008 年间因新发 HF 住院的弗雷明汉心脏研究（FHS）712 名参与者中（中位年龄 81 岁，53%为女性），46%有 HFPEF（EF>45%），54%有 HFREF（EF≤45%）。在多变量逻辑回归中，冠心病（CHD）、更高的心率、更高的钾、左束支传导阻滞和缺血性心电图改变增加了 HFREF 的可能性；女性和心房颤动增加了 HFPEF 的可能性。总的来说，这些临床特征对 HF 亚型具有良好的预测能力（c 统计量为 0.78）。在增强有效心脏治疗反馈（EFFECT）研究中检查了这些预测因素。在 4436 名 HF 患者中（中位年龄 75 岁，47%为女性），32%有 HFPEF，68%有 HFREF。FHS 和 EFFECT 之间的鉴别临床特征一致，EFFECT 的区分度相当（c 统计量为 0.75）。在探索性分析中，检查 EF 中间组（EF 35-55%）的特征时，CHD 易导致 EF 降低，而其他临床特征在 HFPEF 和 HFREF 之间显示出重叠的谱。
新发 HF 患者中，HFPEF 与 HFREF 患者的初始 HF 表现时有多个临床特征不同。虽然 CHD 显然与较低的 EF 相关，但在左心室 EF 范围谱的中间也观察到重叠的特征。
