与射血分数降低和射血分数保留的心衰患者相比，射血分数中间值的心衰患者的特征和长期预后：系统评价和荟萃分析。
Characteristics and long-term prognosis of patients with heart failure and mid-range ejection fraction compared with reduced and preserved ejection fraction: a systematic review and meta-analysis.
机构信息
Division of Cardiology, Department of Internal Medicine, Copenhagen University Hospital of Glostrup, Glostrup, 2600, Denmark.
Department of Cardiology B, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
出版信息
ESC Heart Fail. 2018 Aug;5(4):685-694. doi: 10.1002/ehf2.12283. Epub 2018 Apr 16.
AIMS
This study aimed to assess by a meta-analysis the clinical characteristics, all-cause and cardiovascular mortality, and hospitalization of patients with heart failure (HF) with mid-range ejection fraction (HFmrEF) compared with HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF).
METHODS AND RESULTS
Data from 12 eligible observational studies including 109 257 patients were pooled. HFmrEF patients were significantly different and occupied a mid-position between HFrEF and HFpEF: mean age 73.6 ± 9.8 vs. 72.6 ± 9.8 and 77.6 ± 7.2 years, male gender 59% vs. 68.5% and 40%, ischaemic heart disease 49% vs. 52.6% and 39.4%, hypertension 67.3% vs. 61.5% and 76.5%, atrial fibrillation 45.2% vs. 39.6% and 46%, chronic obstructive pulmonary disease 26.4% vs. 24.9% and 30.5%, estimated glomerular filtration rate 62 ± 30 vs. 63.3 ± 23 and 59 ± 22.5, use of renin-angiotensin system inhibitors 79.6% vs. 90.1% and 68.7%, beta-blockers 82% vs. 89% and 73.5%, and aldosterone antagonists 20.3 vs. 31.5% and 26%, P-values < 0.05. After a mean follow-up of 31 ± 5 months, all-cause mortality was significantly lower in HFmrEF than in HFrEF and HFpEF (26.8% vs. 29.5% and 31%): risk ratio (RR) 0.95 [0.93-0.98; 95% confidence interval (CI)], P < 0.001, and 0.97 (0.94-0.99; 95% CI), P = 0.014, respectively. Cardiovascular mortality was lowest in HFmrEF (9.7% vs. 13% and 12.8%): RR = 0.81 (0.73-0.91), P < 0.001, and 1.10 (0.97-1.24; 95% CI), P = 0.13, respectively. HF hospitalization in HFmrEF compared to that in HFrEF and HFpEF was 23.9% vs. 27.6% and 23.3% with RR = 0.89 (0.85-0.93), P < 0.001, and RR = 1.12 (1.07-1.17), P < 0.001, respectively.
CONCLUSIONS
The results of this study support that HFmrEF is a distinct category characterized by a mid-position between HFrEF and HFpEF and with the lowest all-cause and cardiovascular mortality.
目的
本研究旨在通过荟萃分析评估射血分数中间值的心衰（HFmrEF）患者与射血分数降低的心衰（HFrEF）和射血分数保留的心衰（HFpEF）患者的临床特征、全因死亡率和心血管死亡率以及住院情况。
方法和结果
纳入了 12 项符合条件的观察性研究，共纳入 1095257 例患者的数据。HFmrEF 患者与 HFrEF 和 HFpEF 患者存在显著差异，并处于中间位置：平均年龄分别为 73.6±9.8 岁、72.6±9.8 岁和 77.6±7.2 岁，男性分别为 59%、68.5%和 40%，缺血性心脏病分别为 49%、52.6%和 39.4%，高血压分别为 67.3%、61.5%和 76.5%，心房颤动分别为 45.2%、39.6%和 46%，慢性阻塞性肺疾病分别为 26.4%、24.9%和 30.5%，肾小球滤过率估计值分别为 62±30 毫升/分钟、63.3±23 毫升/分钟和 59±22.5 毫升/分钟，肾素-血管紧张素系统抑制剂的使用率分别为 79.6%、90.1%和 68.7%，β受体阻滞剂的使用率分别为 82%、89%和 73.5%，醛固酮拮抗剂的使用率分别为 20.3%、31.5%和 26%，P 值均<0.05。在平均 31±5 个月的随访后，HFmrEF 的全因死亡率明显低于 HFrEF 和 HFpEF（26.8%、29.5%和 31%）：风险比（RR）分别为 0.95（0.93-0.98），P<0.001，和 0.97（0.94-0.99），P=0.014。HFmrEF 的心血管死亡率最低（9.7%、13%和 12.8%）：RR 分别为 0.81（0.73-0.91），P<0.001，和 1.10（0.97-1.24），P=0.13。与 HFrEF 和 HFpEF 相比，HFmrEF 的 HF 住院率为 23.9%、27.6%和 23.3%，RR 分别为 0.89（0.85-0.93），P<0.001，和 1.12（1.07-1.17），P<0.001。
结论
本研究结果支持 HFmrEF 是一种独特的类别，其特征为介于 HFrEF 和 HFpEF 之间，且全因死亡率和心血管死亡率最低。
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