1 Julius Center for Health Sciences and Primary Care, Utrecht University, The Netherlands.
2 Laboratory for Experimental Cardiology, Utrecht University, The Netherlands.
Eur J Prev Cardiol. 2019 Apr;26(6):613-623. doi: 10.1177/2047487318816774. Epub 2018 Nov 27.
The prevalence of undetected left ventricular diastolic dysfunction is high, especially in the elderly with comorbidities. Left ventricular diastolic dysfunction is a prognostic indicator of heart failure, in particularly of heart failure with preserved ejection fraction and of future cardiovascular and all-cause mortality. Therefore we aimed to develop sex-specific diagnostic models to enable the early identification of men and women at high-risk of left ventricular diastolic dysfunction with or without symptoms of heart failure who require more aggressive preventative strategies.
Individual patient data from four primary care heart failure-screening studies were analysed (1371 participants, excluding patients classified as heart failure and left ventricular ejection fraction <50%).
Eleven candidate predictors were entered into logistic regression models to be associated with the presence of left ventricular diastolic dysfunction/heart failure with preserved ejection fraction in men and women separately. Internal-external cross-validation was performed to develop and validate the models.
Increased age and β-blocker therapy remained as predictors in both the models for men and women. The model for men additionally consisted of increased body mass index, moderate to severe shortness of breath, increased pulse pressure and history of ischaemic heart disease. The models performed moderately and similarly well in men (c-statistics range 0.60-0.75) and women (c-statistics range 0.51-0.76) and the performance improved significantly following the addition of N-terminal pro b-type natriuretic peptide (c-statistics range 0.61-0.80 in women and 0.68-0.80 in men).
We provide an easy-to-use screening tool for use in the community, which can improve the early detection of left ventricular diastolic dysfunction/heart failure with preserved ejection fraction in high-risk men and women and optimise tailoring of preventive interventions.
未被检测出的左心室舒张功能障碍的患病率很高，尤其是患有合并症的老年人。左心室舒张功能障碍是心力衰竭的预后指标，特别是射血分数保留的心力衰竭以及未来心血管和全因死亡率的预后指标。因此，我们旨在开发性别特异性诊断模型，以便能够早期识别有或无症状心力衰竭且患有左心室舒张功能障碍风险较高的男性和女性，并为他们提供更积极的预防策略。
对四项初级保健心力衰竭筛查研究的个体患者数据进行了分析（排除了被归类为心力衰竭和左心室射血分数<50%的患者，共 1371 名参与者）。
将 11 个候选预测因素纳入逻辑回归模型，以分别与男性和女性的左心室舒张功能障碍/射血分数保留心力衰竭的存在相关联。进行内部-外部交叉验证以开发和验证模型。
年龄和β受体阻滞剂治疗的增加仍然是男性和女性模型中的预测因素。男性模型还包括体重指数增加、中度至重度呼吸困难、脉压增加和缺血性心脏病史。该模型在男性（c 统计范围 0.60-0.75）和女性（c 统计范围 0.51-0.76）中的表现中等且相当好，并且在添加 N 末端 pro B 型利钠肽后，性能显著提高（女性 c 统计范围 0.61-0.80，男性 c 统计范围 0.68-0.80）。
我们提供了一种易于在社区中使用的筛查工具，可以改善高危男性和女性中左心室舒张功能障碍/射血分数保留心力衰竭的早期检测，并优化预防干预措施的针对性。
