Baker Heart & Diabetes Institute, Melbourne, Australia.
University of Melbourne (Western Clinical School), Melbourne, Australia; Department of Cardiology-Western Health, The University of Melbourne, Melbourne, Australia.
JACC Cardiovasc Imaging. 2019 May;12(5):798-806. doi: 10.1016/j.jcmg.2017.10.023. Epub 2018 Feb 14.
This study aimed to determine the association of stage B heart failure (SBHF) and its constituent left ventricular (LV) abnormalities with trajectory of exercise capacity over time, and assess whether this association is modified by reversion of these LV abnormalities to normal.
The LV abnormalities of SBHF may coincide with a reduction in exercise capacity that precedes the overt exercise intolerance of clinical heart failure (HF). Determining the predictive capacity of established and novel SBHF criteria for exercise capacity decline may improve HF risk stratification.
LV structure/function (echocardiography) and exercise capacity (6-min walk distance [6MWD]) were assessed at baseline and 3-year follow-up in 268 patients from the NIL-CHF (Nurse-led Intervention for Less Chronic Heart Failure) study (all stage A [SAHF] or SBHF). Changes (Δ) in 6MWD were compared between SAHF and SBHF and across each of 4 constituent components of SBHF: LV hypertrophy, regional wall motion abnormality(ies) (RWMA), left ventricular systolic dysfunction (LVSD) (ejection fraction <45%) and elevated early diastolic filling/annular velocity ratio (E/e' ≥15).
Δ6MWD was similar in those with SAHF (n = 141) and SBHF (n = 127; -5 m [95% confidence interval (CI): -21 to +11 m]; covariate-adjusted). However, within the setting of SBHF there was substantive heterogeneity; that is, reductions in 6MWD were observed with persistent elevated E/e' (-34 m [95% CI: -62 to -6 m]) and persistent LVSD (-41 m [95% CI: -74 to -8 m]), but not with LV hypertrophy (+17 m [95% CI: -15 to +49 m) or RWMA (+5 m [-27 to +36 m]), nor in patients whose elevated E/e' or LVSD reverted to normal by 3 years (p > 0.10).
Elevated E/e' is associated with a similar degree of exercise capacity decline to LVSD, supporting that both LV functional criteria be considered in distinguishing SBHF from SAHF. That reversion of either manifestation of LV dysfunction was associated with preserved exercise capacity advocates targeting of these factors by HF preventive interventions.
本研究旨在确定 B 期心力衰竭（SBHF）及其构成的左心室（LV）异常与随时间推移的运动能力轨迹之间的关系，并评估这种关系是否因这些 LV 异常恢复正常而改变。
SBHF 的 LV 异常可能与运动耐量降低同时发生，而后者先于临床心力衰竭（HF）的明显运动不耐受。确定既定和新型 SBHF 标准对运动能力下降的预测能力可能会改善 HF 风险分层。
在 NIL-CHF（护士主导的干预以减少慢性心力衰竭）研究中，对 268 名患者进行了基线和 3 年随访时的 LV 结构/功能（超声心动图）和运动能力（6 分钟步行距离[6MWD]）评估（均为 A 期[SAHF]或 SBHF）。比较了 SAHF 和 SBHF 之间以及 SBHF 的 4 个构成部分（LV 肥大、局部壁运动异常[RWMA]、LV 收缩功能障碍[射血分数<45%]和早期舒张充盈/环速度比升高[E/e'≥15]）之间的 6MWD 变化（Δ）。
SAHF（n=141）和 SBHF（n=127）患者的Δ6MWD 相似（-5 m [95%置信区间（CI）：-21 至+11 m]；经协变量调整）。然而，在 SBHF 的情况下存在实质性异质性；也就是说，持续升高的 E/e'（-34 m [95% CI：-62 至-6 m]）和持续的 LVSD（-41 m [95% CI：-74 至-8 m]）与 6MWD 下降有关，但 LV 肥大（+17 m [95% CI：-15 至+49 m]）或 RWMA（+5 m [-27 至+36 m]）则没有，而且那些 E/e'或 LVSD 升高的患者在 3 年内恢复正常也没有（p>0.10）。
E/e'升高与 LVSD 导致的运动能力下降程度相似，这支持在区分 SBHF 与 SAHF 时应考虑这两种 LV 功能标准。LV 功能异常的任何一种表现的逆转与运动能力的保持有关，这表明 HF 预防干预应针对这些因素。
