Kontogeorgos Silvana, Thunström Erik, Johansson Magnus C, Fu Michael
Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, 416 50 Gothenburg, Sweden.
Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, 416 50 Gothenburg, Sweden.
Int J Cardiol. 2017 Apr 1;232:86-92. doi: 10.1016/j.ijcard.2017.01.048. Epub 2017 Jan 5.
The issue of whether prognosis is similar between heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF) remains unresolved. Because of the problem of inconsistency in the diagnostic criteria and because there is currently no lifesaving therapy available for HFpEF, it seems to be the right time to study the outcome of a clearly defined HFpEF compared with HFrEF in contemporary heart failure (HF) therapy. This study investigates 5-year-mortality and its prognostic factors in old patients with HFpEF compared with those with HFrEF.
This is a retrospective study. Patients hospitalized at Sahlgrenska University Hospital/Ostra for HF were consecutively included between May 2007 and April 2008. Diagnosis were reviewed and re-evaluated for each patient. The outcome measure was all-cause mortality and collected from May 2007 and 2013.
Mean age of the study population (n=289) was 79±7years. One third of the HF cohort had HFpEF. When adjusted for age HFrEF patients had a 42% higher 5-year mortality than HFpEF. By logistic regression analysis age, female sex, pulmonary disease, renal dysfunction, loop diuretics and aldosterone receptor antagonist were negatively associated with prognosis in HFpEF, whereas angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACEi/ARBs) and Statins were positive prognostic factors. In HFrEF age, atrial fibrillation, NT-proBNP and loop diuretics were negative predictive factors, while treated hypertension, percutaneous coronary intervention, ACEi/ARBs and beta-blockers were positive factors for survival.
HFpEF proved to have a better long-term prognosis than HFrEF and a distinct prognostic risk profile.
射血分数保留的心力衰竭（HFpEF）和射血分数降低的心力衰竭（HFrEF）的预后是否相似这一问题仍未得到解决。由于诊断标准不一致的问题，且目前尚无针对HFpEF的挽救生命的治疗方法，因此，在当代心力衰竭（HF）治疗中，研究明确界定的HFpEF与HFrEF相比的结局似乎时机正好。本研究调查了老年HFpEF患者与HFrEF患者的5年死亡率及其预后因素。
这是一项回顾性研究。2007年5月至2008年4月期间，连续纳入在萨尔格伦斯卡大学医院/东院区因HF住院的患者。对每位患者的诊断进行复查和重新评估。结局指标为全因死亡率，数据收集时间为2007年5月至2013年。
研究人群（n = 289）的平均年龄为79±7岁。HF队列中有三分之一的患者为HFpEF。在对年龄进行校正后，HFrEF患者的5年死亡率比HFpEF患者高42%。通过逻辑回归分析，年龄、女性、肺部疾病、肾功能不全、襻利尿剂和醛固酮受体拮抗剂与HFpEF的预后呈负相关，而血管紧张素转换酶抑制剂/血管紧张素II受体阻滞剂（ACEi/ARBs）和他汀类药物是阳性预后因素。在HFrEF中，年龄、心房颤动、NT-proBNP和襻利尿剂是阴性预测因素，而治疗性高血压、经皮冠状动脉介入治疗、ACEi/ARBs和β受体阻滞剂是生存的阳性因素。
事实证明，HFpEF的长期预后优于HFrEF，且具有独特的预后风险特征。
