不同射血分数心力衰竭患者脉压与死亡率的关系：射血分数降低、中间范围和保留。
Different relationships between pulse pressure and mortality in heart failure with reduced, mid-range and preserved ejection fraction.
机构信息
National Heart Centre Singapore, 5 Hospital Drive, 169609, Singapore; School of Population Health, University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia.
National Heart Centre Singapore, 5 Hospital Drive, 169609, Singapore.
出版信息
Int J Cardiol. 2018 Mar 1;254:203-209. doi: 10.1016/j.ijcard.2017.09.187. Epub 2018 Jan 28.
OBJECTIVES/BACKGROUND: In heart failure (HF), pulse pressure (PP) may reflect both vascular stiffness and left ventricular function, but its prognostic role in relation to ejection fraction (EF) is poorly understood.
METHODS
In the Swedish Heart Failure Registry, we investigated the association between PP and 1-year mortality in patients with HF and reduced (HFrEF, <40%), mid-range (HFmrEF, 40-49%) and preserved EF (HFpEF, ≥50%), using multivariable logistic regression and restricted cubic splines.
RESULTS
Among 36,770 patients discharged alive or enrolled as out-patients with 1-year follow-up (mean age 74±12years, 63% men, 56% HFrEF, 21% HFmrEF, 23% HFpEF), crude one-year mortality was 18%. Mean PP increased across EF groups: 51±16 in HFrEF, 57±18 in HFmrEF, 60±19mmHg in HFpEF. In crude regression splines, the association between PP and mortality was U-shaped in HFmrEF and HFpEF, but curvilinear with only low PP associated with mortality in HFrEF. In multivariable analyses, a significant interaction by EF group and PP was observed (p=0.015): low PP was associated with higher mortality in HFrEF (adjusted OR [1st vs. 4th quintile]=1.40, 95% CI 1.18-1.67) and HFpEF (1.43, 1.14-1.81) but only by trend in HFmrEF; high PP had a trend towards higher mortality in HFmrEF (5th vs. 3rd quintile=1.30, 1.00-1.69) and HFpEF (1.25, 0.98-1.61).
CONCLUSIONS
The association between PP and mortality in HF was influenced by EF. Low PP was independently associated with mortality in HFrEF and HFpEF and by trend in HFmrEF. High PP was independently associated with mortality by trend in HFmrEF and HFpEF.
目的/背景：在心力衰竭（HF）中，脉压（PP）可能反映血管硬度和左心室功能，但它与射血分数（EF）的预后关系尚不清楚。
方法
在瑞典心力衰竭注册中心，我们使用多变量逻辑回归和限制立方样条，研究了 HF 患者（射血分数降低型 HFrEF，<40%；射血分数中间范围型 HFmrEF，40-49%；射血分数保留型 HFpEF，≥50%）PP 与 1 年死亡率之间的关系。
结果
在 36770 名存活出院或接受 1 年随访的门诊患者（平均年龄 74±12 岁，63%为男性，56%为 HFrEF，21%为 HFmrEF，23%为 HFpEF）中，粗死亡率为 18%。平均 PP 随着 EF 组的增加而增加：HFrEF 为 51±16mmHg，HFmrEF 为 57±18mmHg，HFpEF 为 60±19mmHg。在未校正回归样条中，PP 与死亡率之间呈 U 型关系，但 HFmrEF 和 HFpEF 呈曲线关系，仅低 PP 与 HFrEF 死亡率相关。在多变量分析中，EF 组和 PP 之间存在显著的交互作用（p=0.015）：低 PP 与 HFrEF（调整后 OR [1 分位比第 4 分位]=1.40，95%CI 1.18-1.67）和 HFpEF（1.43，1.14-1.81）的死亡率升高相关，但在 HFmrEF 中仅呈趋势相关；高 PP 与 HFmrEF（第 5 分位比第 3 分位=1.30，1.00-1.69）和 HFpEF（1.25，0.98-1.61）的死亡率升高趋势相关。
结论
PP 与 HF 死亡率之间的关系受 EF 影响。低 PP 与 HFrEF 和 HFpEF 的死亡率独立相关，HFmrEF 呈趋势相关。高 PP 与 HFmrEF 和 HFpEF 的死亡率升高趋势独立相关。
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