Division of Cardiac Anesthesiology, Department of Anesthesiology and Pain Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada.
J Am Heart Assoc. 2018 Jun 16;7(12):e008902. doi: 10.1161/JAHA.118.008902.
Heart failure (HF) with reduced ejection fraction (rEF) is a widely regarded prognosticator after coronary artery bypass grafting. HF with preserved ejection fraction (pEF) accounts for up to half of all HF cases and is associated with considerable morbidity and mortality in hospitalized cohorts. However, HFpEF outcomes have not been elucidated in cardiac surgical patients. We investigated the prevalence and outcomes of HFpEF and HFrEF in women and men following coronary artery bypass grafting.
We conducted a retrospective cohort study in Ontario, Canada, between October 1, 2008, and March 31, 2015, using Cardiac Care Network and Canadian Institute of Health Information data. HF is captured through a validated population-based database of all Ontarians with physician-diagnosed HF. We defined pEF as ejection fraction ≥50% and rEF as ejection fraction <50%. The primary outcome was all-cause mortality. Analyses were stratified by sex. Mortality rates were calculated using Kaplan-Meier method. The relative hazard of death was assessed using multivariable Cox proportional hazard models. Of 40 083 patients (20.6% women), 55.5% had pEF without HF, 25.7% had rEF without HF, 6.9% had HFpEF, and 12.0% had HFrEF. Age-standardized HFpEF mortality rates at 4±2 years of follow-up were similar in women and men. HFrEF standardized HFpEF mortality rates were higher in women than men.
We found a higher prevalence and poorer prognosis of HFpEF in women. A history of HF was a more important prognosticator than ejection fraction. Preoperative screening and extended postoperative follow-up should be focused on women and men with HF rather than on rEF alone.
射血分数降低的心衰（HFrEF）是冠状动脉旁路移植术后广泛公认的预后因素。射血分数保留的心衰（HFpEF）占所有心衰病例的一半以上，在住院患者队列中与相当高的发病率和死亡率相关。然而，HFpEF 在心外科患者中的结局尚未阐明。我们调查了冠状动脉旁路移植术后女性和男性中 HFpEF 和 HFrEF 的患病率和结局。
我们在加拿大安大略省进行了一项回顾性队列研究，使用心脏护理网络和加拿大卫生信息研究所的数据，时间为 2008 年 10 月 1 日至 2015 年 3 月 31 日。心衰是通过安大略省所有经医生诊断的心衰患者的一个经过验证的基于人群的数据库来捕获的。我们将 EF≥50%定义为 EFpEF，EF<50%定义为 rEF。主要结局是全因死亡率。分析按性别分层。使用 Kaplan-Meier 方法计算死亡率。使用多变量 Cox 比例风险模型评估死亡的相对风险。在 40083 名患者（20.6%为女性）中，55.5%没有心衰的 EFpEF，25.7%没有心衰的 rEF，6.9%有心衰的 HFpEF，12.0%有 HFrEF。在 4±2 年的随访中，标准化的 HFpEF 死亡率在女性和男性中相似。女性的 HFrEF 标准化 HFpEF 死亡率高于男性。
我们发现女性 HFpEF 的患病率更高，预后更差。心衰病史是比射血分数更重要的预后因素。术前筛查和延长术后随访应侧重于有心衰的女性和男性，而不仅仅是 rEF。
