Donal Erwan, Lund Lars H, Oger Emmanuel, Bosseau Christian, Reynaud Amélie, Hage Camilla, Drouet Elodie, Daubert J-Claude, Linde Cecila
Cardiologie, CHU Rennes, 35000 RENNES, France.
CIC-IT 1414, Université Rennes-1, 35000 Rennes, France.
Eur Heart J Cardiovasc Imaging. 2017 Jun 1;18(6):629-635. doi: 10.1093/ehjci/jex005.
Heart failure with preserved ejection fraction (HFpEF) is a complex syndrome with various phenotypes and outcomes. The prognostic relevance of echocardiography and the E/e' ratio has previously been reported. We sought to study in addition, the value of estimated pulmonary pressure and left atrial size for diagnosing and determining a prognosis for HFpEF-patients in a prospective multi-centric cohort.
Patients with an acute-HF event accompanied with NT-proBNP >300 pg/mL (BNP >100 pg/mL) and LVEF >45% were included (n = 237) and clinically reassessed using echo-Doppler after 4-8 weeks of HF treatment as part of the prospective KaRen HFpEF study. A core-centre performed the echocardiographic analyses. A combined primary endpoint of either HF hospitalizations and mortality over a span of 18-month, or simply mortality (secondary endpoint) were used. The mean LVEF was 62 ± 7%, E/e':12.9 ± 6.0, left atrial volume index (LAVI): 48.1 ± 15.9 ml/m2, TR: 2.9 ± 0.9 m/s. Patients with both LAVI > 40 ml/m2 and TR > 3.1 m/s had a significantly greater risk of death or heart failure related hospitalization than others (P = 0.014 after adjustment).
The combination of enlarged LA and elevated estimated pulmonary pressure has a strong prognostic impact in patients suffering from HFpEF. Our results indicate that such patients constitute a risk group in HFpEF which requires dedicated medical attention.
CLINICALTRIALS.GOV: NCT00774709.
射血分数保留的心力衰竭（HFpEF）是一种具有多种表型和结局的复杂综合征。先前已有关于超声心动图及E/e'比值预后相关性的报道。我们试图在前瞻性多中心队列研究中，进一步探讨估计肺动脉压力和左心房大小对HFpEF患者的诊断及预后判定价值。
纳入急性心力衰竭事件且NT-proBNP＞300 pg/mL（BNP＞100 pg/mL）、左心室射血分数（LVEF）＞45%的患者（n = 237），作为前瞻性KaRen HFpEF研究的一部分，在心力衰竭治疗4 - 8周后使用超声多普勒进行临床重新评估。由一个核心中心进行超声心动图分析。采用18个月内心力衰竭住院和死亡的联合主要终点，或单纯死亡（次要终点）。平均LVEF为62±7%，E/e'为12.9±6.0，左心房容积指数（LAVI）为48.1±15.9 ml/m²，三尖瓣反流速度（TR）为2.9±0.9 m/s。LAVI＞40 ml/m²且TR＞3.1 m/s的患者比其他患者发生死亡或心力衰竭相关住院的风险显著更高（调整后P = 0.014）。
左心房增大与估计肺动脉压力升高相结合，对HFpEF患者具有强烈的预后影响。我们的结果表明，这类患者在HFpEF中构成一个高危组，需要专门的医疗关注。
NCT00774709。
