Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic Rochester, Rochester, Minnesota; Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, Korea.
Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic Rochester, Rochester, Minnesota; Department of Cardiology, Institute of Clinical and Experimental Medicine-IKEM, Prague, Czech Republic.
J Am Coll Cardiol. 2014 Jul 1;63(25 Pt A):2817-27. doi: 10.1016/j.jacc.2014.03.034. Epub 2014 Apr 23.
This study investigated the characteristics, evaluation, prognostic impact, and treatment of coronary artery disease (CAD) in patients with heart failure and preserved ejection fraction (HFpEF).
CAD is common in patients with HFpEF, but it remains unclear how CAD should be categorized, evaluated for, and treated in HFpEF.
Clinical, hemodynamic, echocardiographic, treatment, and outcome characteristics were examined in consecutive patients with previous HFpEF hospitalizations who underwent coronary angiography.
Of the 376 HFpEF patients examined, 255 (68%) had angiographically-proven CAD. Compared with HFpEF patients without CAD, patients with CAD were more likely to be men, to have CAD risk factors, and to be treated with anti-ischemic medications. However, symptoms of angina and heart failure were similar in patients with and without CAD, as were measures of cardiovascular structure, function, and hemodynamics. Compared with patients without CAD, HFpEF patients with CAD displayed greater deterioration in ejection fraction and increased mortality, independent of other predictors (hazard ratio: 1.71, 95% confidence interval: 1.03 to 2.98; p = 0.04). Complete revascularization was associated with less deterioration in ejection fraction and lower mortality compared with patients who were not completely revascularized, independent of other predictors (hazard ratio: 0.56, 95% confidence interval: 0.33 to 0.93; p = 0.03).
CAD is common in patients with HFpEF and is associated with increased mortality and greater deterioration in ventricular function. Revascularization may be associated with preservation of cardiac function and improved outcomes in patients with CAD. Given the paucity of effective treatments for HFpEF, prospective trials are urgently needed to determine the optimal evaluation and management of CAD in HFpEF.
本研究旨在探讨心力衰竭伴射血分数保留（HFpEF）患者中冠心病（CAD）的特征、评估、预后影响和治疗方法。
CAD 在 HFpEF 患者中较为常见，但 CAD 应如何分类、评估和治疗 HFpEF 患者仍不清楚。
对连续接受冠状动脉造影的既往 HFpEF 住院患者的临床、血流动力学、超声心动图、治疗和结局特征进行了检查。
在 376 例 HFpEF 患者中，255 例（68%）经冠状动脉造影证实为 CAD。与无 CAD 的 HFpEF 患者相比，CAD 患者更可能为男性，有 CAD 危险因素，且接受抗缺血药物治疗。然而，有 CAD 和无 CAD 的 HFpEF 患者的心绞痛和心力衰竭症状相似，心血管结构、功能和血流动力学的测量指标也相似。与无 CAD 的患者相比，HFpEF 合并 CAD 患者的射血分数恶化更明显，死亡率更高，独立于其他预测因素（危险比：1.71，95%置信区间：1.03 至 2.98；p=0.04）。与未完全血运重建的患者相比，完全血运重建与射血分数恶化减少和死亡率降低相关，独立于其他预测因素（危险比：0.56，95%置信区间：0.33 至 0.93；p=0.03）。
CAD 在 HFpEF 患者中较为常见，与死亡率增加和心室功能恶化相关。血运重建可能与 CAD 患者心脏功能的保存和结局的改善相关。鉴于 HFpEF 治疗方法有限，迫切需要前瞻性试验来确定 HFpEF 中 CAD 的最佳评估和管理方法。
