Division of Cardiology, Internal Medicine University Department, Kantonsspital Baselland, 4101 Bruderholz, Switzerland.
Division of Cardiology, University Hospital, University of Basel, Petersgraben 4, 4031 Basel, Switzerland; Department of Cardiology, Maastricht University Medical Center, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
Eur J Intern Med. 2018 Nov;57:61-69. doi: 10.1016/j.ejim.2018.06.005. Epub 2018 Jun 13.
Whether the clinical presentation and in particular prevalence of symptoms and signs of heart failure (HF) is different in elderly versus younger patients and in those with reduced (HFrEF) versus preserved (HFpEF) left ventricular ejection fraction (LVEF) is a matter of ongoing debate.
To compare detailed clinical characteristics of these important subgroups and to develop a prediction rule for the differentiation of HFpEF and HFrEF based on clinical parameters.
The analysis was based on the Trial of Intensified versus standard Medical therapy in Elderly patients with Congestive Heart Failure (TIME-CHF) comprising 622 patients ≥60 years with HF including the whole LVEF spectrum.
In the groups ≥75 years and with HFpEF typical symptoms and clinical signs of HF were more prevalent as compared to those <75 years or with HFrEF, respectively. The burden of comorbidities was higher in the older age group. HFrEF could not be differentiated from HFpEF by symptom history and clinical examination alone. However, a combination of age, presence of pulmonary rales, systolic blood pressure, cause of heart failure, osteoporosis, current smoking, NT-proBNP, haemoglobin, QRS width and heart rhythm allowed to identify HFrEF versus HFpEF with a sensitivity of 81% and specificity of 90% (c-statistics 0.91).
More symptoms and signs of HF were present both in the older age group and in patients with HFpEF. HFpEF versus HFrEF could be differentiated by a set of simple clinical, laboratory and ECG parameters but not by symptom history and physical examination alone.
心力衰竭（HF）患者的临床表现，尤其是症状和体征的患病率，在老年患者与年轻患者、射血分数降低型心力衰竭（HFrEF）与射血分数保留型心力衰竭（HFpEF）患者之间是否存在差异，这是一个持续存在争议的问题。
比较这些重要亚组的详细临床特征，并基于临床参数制定用于区分 HFpEF 和 HFrEF 的预测规则。
该分析基于包含充血性心力衰竭（HF）老年患者强化与标准药物治疗试验（TIME-CHF），共纳入 622 名年龄≥60 岁且 LVEF 谱完整的 HF 患者。
与年龄<75 岁或 HFrEF 患者相比，≥75 岁患者和 HFpEF 患者HF 的典型症状和体征更为常见。年龄较大的患者合并症负担更高。仅通过症状史和临床检查无法区分 HFrEF 和 HFpEF。然而，年龄、肺部啰音、收缩压、心力衰竭病因、骨质疏松症、当前吸烟、NT-proBNP、血红蛋白、QRS 宽度和心律的综合组合可识别 HFrEF 与 HFpEF，其敏感性为 81%，特异性为 90%（C 统计量 0.91）。
在老年患者和 HFpEF 患者中，HF 的症状和体征更为常见。HFpEF 与 HFrEF 可通过一组简单的临床、实验室和心电图参数来区分，但不能仅通过症状史和体格检查来区分。
