Sandesara Pratik B, Hammadah Muhammad, Samman-Tahhan Ayman, Kelli Heval M, O'Neal Wesley T
Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia.
Clin Cardiol. 2017 Sep;40(9):692-696. doi: 10.1002/clc.22716. Epub 2017 Apr 26.
Peripheral artery disease (PAD) in heart failure with preserved ejection fraction (HFpEF) is associated with an increased mortality risk, but the risk of individual outcomes associated with PAD in this patient group is less clear.
PAD is associated with adverse outcomes in HFpEF, including hospitalization and specific cardiovascular outcomes.
We examined the association between PAD and adverse outcomes in 3385 patients with HFpEF (mean age, 69 ± 9.6 years; 49% male; 89% white) from the Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist Trial (TOPCAT). Baseline PAD was identified by self-reported history and medical-record review. The following outcomes were adjudicated by a clinical endpoint committee: hospitalization, hospitalization for heart failure (HF), myocardial infarction, stroke, death, and cardiovascular death.
Over a median follow-up of 3.4 years (interquartile range, 2.0-4.9 years), an increased risk for hospitalization (hazard ratio [HR]: 1.36, 95% confidence interval [CI]: 1.16-1.60), myocardial infarction (HR: 1.69, 95% CI: 1.07-2.67), death (HR: 1.56, 95% CI: 1.22-1.99), and cardiovascular death (HR: 1.53, 95% CI: 1.12-2.10) was observed for those with PAD compared with those without PAD. PAD was not associated with incident stroke. The association between PAD and hospitalization for HF was limited to participants with prior history of HF hospitalization (n = 2449; HR: 1.51, 95% CI: 1.09-2.13).
PAD increases the risk for adverse outcomes in HFpEF and is associated with HF rehospitalization. Practitioners should be aware of the inherent risk associated with PAD in HFpEF.
射血分数保留的心力衰竭（HFpEF）患者中的外周动脉疾病（PAD）与死亡风险增加相关，但该患者群体中与PAD相关的个体结局风险尚不清楚。
PAD与HFpEF的不良结局相关，包括住院和特定心血管结局。
我们在醛固酮拮抗剂治疗射血分数保留的心力衰竭试验（TOPCAT）的3385例HFpEF患者（平均年龄69±9.6岁；49%为男性；89%为白人）中研究了PAD与不良结局之间的关联。通过自我报告病史和病历审查确定基线PAD。以下结局由临床终点委员会判定：住院、因心力衰竭（HF）住院、心肌梗死、中风、死亡和心血管死亡。
在中位随访3.4年（四分位间距2.0 - 4.9年）期间，与无PAD者相比，有PAD者住院风险增加（风险比[HR]：1.36，95%置信区间[CI]：1.16 - 1.60）、心肌梗死风险增加（HR：1.69，95% CI：1.07 - 2.67）、死亡风险增加（HR：1.56，95% CI：1.22 - 1.99）以及心血管死亡风险增加（HR：1.53，95% CI：1.12 - 2.10）。PAD与新发中风无关。PAD与因HF住院之间的关联仅限于有HF住院史的参与者（n = 2449；HR：1.51，95% CI：1.09 - 2.13）。
PAD增加HFpEF患者不良结局的风险，并与HF再次住院相关。从业者应意识到HFpEF患者中与PAD相关的固有风险。
