Pôle cardiovasculaire et thoracique, Centre Hospitalier Universitaire Amiens, Amiens, France; Service de Cardiologie, Centre Hospitalier de Saint Quentin, Saint Quentin, France.
Eur J Heart Fail. 2014 Sep;16(9):967-76. doi: 10.1002/ejhf.142. Epub 2014 Aug 11.
The prognostic impact of coronary artery disease (CAD) in heart failure is debated. Whereas causes of death have been well described in patients with cardiomyopathy, little is known about how CAD influences causes of death in heart failure with preserved ejection fraction (HFPEF). We undertook a 10-year study and analysed causes of death in relation with CAD in HFPEF and in heart failure with reduced ejection fraction (HFREF).
Our prospective analysis included 591 consecutive patients (320 HFPEF and 271 HFREF) hospitalized for the first time for heart failure during 2000 and followed for 10 years. History of CAD was documented in 25% of HFPEF and 39% of HFREF patients (P < 0.001). Overall, CAD was independently predictive of all-cause and cardiovascular death. CAD had powerful prognostic impact in HFREF [adjusted hazard ratio (HR) 1.60 (1.19-2.15) for all-cause death, and adjusted HR 2.01 (1.38-2.92) for cardiovascular death]. In HFPEF, the association between CAD and cardiovascular death was no longer observed after adjustment [adjusted HR 1.01 (0.69-1.50)]. In HFREF, CAD was associated with increased risk of heart failure-related (adjusted HR 2.03 (1.21-3.43)] and myocardial infarction-related fatal events [adjusted HR 3.84 (1.16-12.7)], while HFPEF patients with CAD appeared at greater risk of sudden death [adjusted HR 2.22 (1.05-4.95)].
The prognostic impact of CAD is different in HFPEF compared with HFREF. Patients with HFPEF and CAD are at high risk of cardiovascular death, especially sudden death.
冠心病（CAD）在心力衰竭中的预后影响存在争议。虽然心肌病患者的死亡原因已有详细描述，但对于 CAD 如何影响射血分数保留心力衰竭（HFPEF）患者的死亡原因知之甚少。我们进行了一项为期 10 年的研究，并分析了与 CAD 相关的 HFPEF 和射血分数降低心力衰竭（HFREF）患者的死亡原因。
我们的前瞻性分析包括 591 例连续患者（320 例 HFPEF 和 271 例 HFREF），这些患者在 2000 年因首次心力衰竭住院，并随访了 10 年。HFPEF 和 HFREF 患者中分别有 25%和 39%有 CAD 病史（P<0.001）。总体而言，CAD 是全因和心血管死亡的独立预测因素。CAD 在 HFREF 中具有强大的预后影响[全因死亡的校正风险比（HR）为 1.60（1.19-2.15），心血管死亡的校正 HR 为 2.01（1.38-2.92）]。在 HFPEF 中，CAD 与心血管死亡之间的关联在调整后不再观察到[校正 HR 1.01（0.69-1.50）]。在 HFREF 中，CAD 与心力衰竭相关（校正 HR 2.03（1.21-3.43））和心肌梗死相关的致命事件风险增加相关[校正 HR 3.84（1.16-12.7）]，而 HFPEF 合并 CAD 的患者发生猝死的风险更高[校正 HR 2.22（1.05-4.95）]。
CAD 在 HFPEF 中的预后影响与 HFREF 不同。HFPEF 合并 CAD 的患者心血管死亡风险较高，尤其是猝死风险。
