Departments of Cardiovascular Medicine and Evidence-based Cardiovascular Medicine, Tohoku University Graduate School of Medicine.
Circ J. 2013;77(12):2954-62. doi: 10.1253/circj.cj-13-0725. Epub 2013 Oct 1.
The appropriate target ranges of heart rate (HR) and systolic blood pressure (SBP) for the management of chronic heart failure (CHF) patients remain to be elucidated in a large-scale cohort study.
We examined 3,029 consecutive CHF patients with sinus rhythm (SR) (mean age, 67.9 years) registered in the Chronic Heart Failure Analysis and Registry in the Tohoku District-2 Study (CHART-2; NCT00418041). There were 357 deaths (11.8%) during the median follow-up of 3.1 years. We first performed the classification and regression tree analysis for mortality, identifying SBP <89 mmHg, HR >70 beats/min and SBP <115 mmHg as the primary, secondary and tertiary discriminators, respectively. According to these, we divided the patients into low- (n=1,131), middle- (n=1,624) and high-risk (n=274) groups with mortality risk <10%, 10-20% and >20%, respectively. The low-risk group was characterized by SBP >115 mmHg and HR <70 beats/min and the high-risk group by SBP <89 mmHg regardless of HR values or SBP 89-115 mmHg and HR >76 beats/min. Multivariate Cox regression analysis revealed that the hazard ratio of all-cause death for low-, middle- and high-risk groups was 1.00 (reference), 1.48 (95% confidence interval (CI): 1.10-1.99, P=0.009) and 2.44 (95% CI 1.66-3.58, P<0.001), respectively. Subgroup analysis revealed that age ≥70 years, diabetes, or reduced left ventricular function had higher hazard ratios in the high-risk group.
The results demonstrate the usefulness of combined risk stratification of HR and SBP in CHF patients with SR.
在大规模队列研究中，仍需要阐明适合慢性心力衰竭（CHF）患者管理的心率（HR）和收缩压（SBP）的适当目标范围。
我们检查了在东北区-2 研究（CHART-2；NCT00418041）中注册的 3029 例窦性节律（SR）连续 CHF 患者（平均年龄 67.9 岁）。在中位数为 3.1 年的随访期间，有 357 例死亡（11.8%）。我们首先对死亡率进行了分类和回归树分析，确定 SBP<89mmHg、HR>70 次/分和 SBP<115mmHg 分别为主要、次要和三级鉴别指标。根据这些指标，我们将患者分为低危（n=1131）、中危（n=1624）和高危（n=274）组，死亡率风险分别<10%、10-20%和>20%。低危组的特征是 SBP>115mmHg 和 HR<70 次/分，高危组的特征是无论 HR 值或 SBP 为 89-115mmHg 和 HR>76 次/分，SBP<89mmHg。多变量 Cox 回归分析显示，低危、中危和高危组全因死亡的危险比分别为 1.00（参考）、1.48（95%置信区间（CI）：1.10-1.99，P=0.009）和 2.44（95%CI 1.66-3.58，P<0.001）。亚组分析显示，年龄≥70 岁、糖尿病或左心室功能降低的高危组具有更高的危险比。
结果表明，在 SR 的 CHF 患者中，HR 和 SBP 的联合风险分层具有一定的实用性。
