University of Medicine Carol Davila, Bucuresti; Institutul de Urgente Boli Cardiovasculare C.C.Iliescu, Bucuresti, Romania.
Department of Cardiology, General Hospital Celje, Slovenia.
Eur J Heart Fail. 2017 Dec;19(12):1574-1585. doi: 10.1002/ejhf.813. Epub 2017 Apr 6.
AIMS: The objectives of the present study were to describe epidemiology and outcomes in ambulatory heart failure (HF) patients stratified by left ventricular ejection fraction (LVEF) and to identify predictors for mortality at 1 year in each group. METHODS AND RESULTS: The European Society of Cardiology Heart Failure Long-Term Registry is a prospective, observational study collecting epidemiological information and 1-year follow-up data in 9134 HF patients. Patients were classified according to baseline LVEF into HF with reduced EF [EF <40% (HFrEF)], mid-range EF [EF 40-50% (HFmrEF)] and preserved EF [EF >50% (HFpEF)]. In comparison with HFpEF subjects, patients with HFrEF were younger (64 years vs. 69 years), more commonly male (78% vs. 52%), more likely to have an ischaemic aetiology (49% vs. 24%) and left bundle branch block (24% vs. 9%), but less likely to have hypertension (56% vs. 67%) or atrial fibrillation (18% vs. 32%). The HFmrEF group resembled the HFrEF group in some features, including age, gender and ischaemic aetiology, but had less left ventricular and atrial dilation. Mortality at 1 year differed significantly between HFrEF and HFpEF (8.8% vs. 6.3%); HFmrEF patients experienced intermediate rates (7.6%). Age, New York Heart Association (NYHA) class III/IV status and chronic kidney disease predicted mortality in all LVEF groups. Low systolic blood pressure and high heart rate were predictors for mortality in HFrEF and HFmrEF. A lower body mass index was independently associated with mortality in HFrEF and HFpEF patients. Atrial fibrillation predicted mortality in HFpEF patients. CONCLUSIONS: Heart failure patients stratified according to different categories of LVEF represent diverse phenotypes of demography, clinical presentation, aetiology and outcomes at 1 year. Differences in predictors for mortality might improve risk stratification and management goals.
目的:本研究旨在描述按左心室射血分数(LVEF)分层的门诊心力衰竭(HF)患者的流行病学和结局,并确定每组患者 1 年死亡率的预测因素。
方法和结果:欧洲心脏病学会心力衰竭长期注册研究是一项前瞻性、观察性研究,共纳入 9134 例 HF 患者,收集流行病学信息和 1 年随访数据。根据基线 LVEF 将患者分为射血分数降低的心力衰竭[EF<40%(HFrEF)]、中间范围射血分数[EF 40-50%(HFmrEF)]和保留射血分数[EF>50%(HFpEF)]。与 HFpEF 患者相比,HFrEF 患者更年轻(64 岁比 69 岁)、更常见为男性(78%比 52%)、更可能存在缺血性病因(49%比 24%)和左束支传导阻滞(24%比 9%),但不太可能患有高血压(56%比 67%)或心房颤动(18%比 32%)。HFmrEF 组在某些特征上与 HFrEF 组相似,包括年龄、性别和缺血性病因,但左心室和心房扩张程度较轻。HFrEF 和 HFpEF 患者 1 年死亡率差异显著(8.8%比 6.3%);HFmrEF 患者死亡率居中(7.6%)。年龄、纽约心脏协会(NYHA)心功能分级 III/IV 级和慢性肾脏病是所有 LVEF 组患者死亡的预测因素。在 HFrEF 和 HFmrEF 中,低收缩压和高心率是死亡率的预测因素。在 HFrEF 和 HFpEF 患者中,低体重指数与死亡率独立相关。心房颤动是 HFpEF 患者死亡的预测因素。
结论:根据不同 LVEF 分类分层的心力衰竭患者代表了不同的人口统计学、临床表现、病因和 1 年结局表型。死亡率预测因素的差异可能会改善风险分层和管理目标。
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