Department of Clinical Medicine and Development, National Cerebral and Cardiovascular Centre, 5-7-1 Fujishirodai, Suita, Osaka, Japan; Department of Cell Biology, National Cerebral and Cardiovascular Centre, 5-7-1 Fujishirodai, Suita, Osaka, Japan.
Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan.
EBioMedicine. 2018 Jul;33:185-195. doi: 10.1016/j.ebiom.2018.06.001. Epub 2018 Jun 20.
In previous retrospective studies, we identified the 50 most influential clinical predictors of cardiovascular outcomes in patients with heart failure (HF). The present study aimed to use the novel limitless-arity multiple-testing procedure to filter these 50 clinical factors and thus yield combinations of no more than four factors that could potentially predict the onset of cardiovascular events. A Kaplan-Meier analysis was used to investigate the importance of the combinations.
In a multi-centre observational trial, we prospectively enrolled 213 patients with HF who were hospitalized because of exacerbation, discharged according to HF treatment guidelines and observed to monitor cardiovascular events. After the observation period, we stratified patients according to whether they experienced cardiovascular events (rehospitalisation or cardiovascular death).
Among 77,562 combinations of fewer than five clinical parameters, we identified 151 combinations that could potentially explain the occurrence of cardiovascular events. Of these, 145 combinations included the use of inotropic agents, whereas the remaining 6 included the use of diuretics without bradycardia or tachycardia, suggesting that the high probability of cardiovascular events is exclusively determined by these two clinical factors. Importantly, Kaplan-Meier curves demonstrated that the use of inotropes or of diuretics without bradycardia or tachycardia were independent predictors of a markedly worse cardiovascular prognosis.
Patients treated with either inotropic agents or diuretics without bradycardia or tachycardia were at a higher risk of cardiovascular events. The uses of these drugs, regardless of heart rate, are the strongest clinical predictors of cardiovascular events in patients with HF.
在之前的回顾性研究中，我们确定了 50 个对心力衰竭（HF）患者心血管结局影响最大的临床预测因素。本研究旨在使用新型无限制多样性多重检验程序对这 50 个临床因素进行筛选，从而得出潜在预测心血管事件发生的不超过四个因素的组合。采用 Kaplan-Meier 分析来研究这些组合的重要性。
在一项多中心观察性试验中，我们前瞻性纳入了 213 名因 HF 恶化而住院、根据 HF 治疗指南出院并观察监测心血管事件的 HF 患者。在观察期结束后，我们根据患者是否经历心血管事件（再住院或心血管死亡）对患者进行分层。
在少于 5 个临床参数的 77562 种组合中，我们确定了 151 种潜在能够解释心血管事件发生的组合。其中，145 种组合包含使用正性肌力药物，而其余 6 种组合包含使用利尿剂但不伴有心动过缓或心动过速，这表明心血管事件发生的高概率仅由这两个临床因素决定。重要的是，Kaplan-Meier 曲线表明，使用正性肌力药物或利尿剂但不伴有心动过缓或心动过速是心血管预后明显恶化的独立预测因素。
接受正性肌力药物或利尿剂治疗但不伴有心动过缓或心动过速的患者发生心血管事件的风险更高。无论心率如何，这些药物的使用是 HF 患者心血管事件的最强临床预测因素。
