Kajimoto Katsuya, Minami Yuichiro, Sato Naoki, Kasanuki Hiroshi
Division of Cardiology, Sekikawa Hospital, Tokyo, Japan.
Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan.
Am J Cardiol. 2016 Dec 15;118(12):1881-1887. doi: 10.1016/j.amjcard.2016.08.080. Epub 2016 Sep 15.
In the setting of acute decompensated heart failure (HF), relations among the etiology of HF, left ventricular systolic function, and outcomes are unclear. The aim of this study was to investigate the association of HF etiology with outcomes in patients with acute decompensated HF with a preserved or reduced ejection fraction (EF). Of the 4,842 patients enrolled in the Acute Decompensated Heart Failure Syndromes registry, 3,810 patients (1,601 with a preserved EF and 2,209 with a reduced EF) who had a hypertensive, ischemic, valvular, or idiopathic dilated etiology of HF were investigated to assess the association of etiology with a composite end point (all-cause mortality and readmission for HF). The median follow-up period after admission was 502 (381 to 759) days. The composite end point was reached in 44.6% and 41.7% of the preserved and reduced EF groups, respectively. After adjustment for multiple co-morbidities, the risk of the composite end point was comparable among hypertensive, ischemic, and valvular etiologies in the preserved EF group. In contrast, in the reduced EF group, ischemic etiology was associated with a tendency toward greater risk of the composite end point than hypertensive etiology (but this difference was not significant), whereas valvular etiology was associated with a significantly greater risk of the composite end point relative to hypertensive or idiopathic dilated etiology. In conclusion, this study demonstrated that taking the etiology of HF into account may help to reduce the heterogeneity of acute decompensated HF and assist in identifying patients at risk of adverse outcomes, especially among patients with reduced EF.
在急性失代偿性心力衰竭（HF）的情况下，HF病因、左心室收缩功能和预后之间的关系尚不清楚。本研究的目的是调查在射血分数（EF）保留或降低的急性失代偿性HF患者中，HF病因与预后的关联。在急性失代偿性心力衰竭综合征登记处登记的4842例患者中，对3810例（1601例EF保留，2209例EF降低）患有高血压、缺血性、瓣膜性或特发性扩张性HF病因的患者进行了调查，以评估病因与复合终点（全因死亡率和HF再入院）的关联。入院后的中位随访期为502（381至759）天。EF保留组和EF降低组分别有44.6%和41.7%达到复合终点。在对多种合并症进行调整后，EF保留组中高血压、缺血性和瓣膜性病因的复合终点风险相当。相比之下，在EF降低组中，缺血性病因与复合终点风险高于高血压病因的趋势相关（但这种差异不显著），而瓣膜性病因与相对于高血压或特发性扩张性病因的复合终点风险显著更高相关。总之，本研究表明，考虑HF病因可能有助于降低急性失代偿性HF的异质性，并有助于识别有不良预后风险的患者，尤其是在EF降低的患者中。
