University Medical Center Groningen, Department of Cardiology, the Netherlands (J.T., C.S.P.L.).
National Heart Centre Singapore (J.T., W.T.T., T.-H.K.T., J.Y., C.S.P.L.).
Circulation. 2018 Dec 11;138(24):2763-2773. doi: 10.1161/CIRCULATIONAHA.118.034720.
Heart failure with preserved ejection fraction (HFpEF), traditionally considered a disease of the elderly, may also affect younger patients. However, little is known about HFpEF in the young.
We prospectively enrolled 1203 patients with HFpEF (left ventricular ejection fraction ≥50%) from 11 Asian regions. We grouped HFpEF patients into very young (<55 years of age; n=157), young (55-64 years of age; n=284), older (65-74 years of age; n=355), and elderly (≥75 years of age; n=407) and compared clinical and echocardiographic characteristics, quality of life, and outcomes across age groups and between very young individuals with HFpEF and age- and sex-matched control subjects without heart failure.
Thirty-seven percent of our HFpEF population was <65 years of age. Younger age was associated with male preponderance and a higher prevalence of obesity (body mass index ≥30 kg/m; 36% in very young HFpEF versus 16% in elderly) together with less renal impairment, atrial fibrillation, and hypertension (all P<0.001). Left ventricular filling pressures and prevalence of left ventricular hypertrophy were similar in very young and elderly HFpEF. Quality of life was better and death and heart failure hospitalization at 1 year occurred less frequently ( P<0.001) in the very young (7%) compared with elderly (21%) HFpEF. Compared with control subjects, very young HFpEF had a 3-fold higher death rate and twice the prevalence of hypertrophy.
Young and very young patients with HFpEF display similar adverse cardiac remodeling compared with their older counterparts and very poor outcomes compared with control subjects without heart failure. Obesity may be a major driver of HFpEF in a high proportion of HFpEF in the young and very young.
射血分数保留的心力衰竭（HFpEF）传统上被认为是老年人的疾病，但也可能影响年轻患者。然而，关于年轻人的 HFpEF 知之甚少。
我们前瞻性纳入了来自 11 个亚洲地区的 1203 名 HFpEF 患者（左心室射血分数≥50%）。我们将 HFpEF 患者分为非常年轻（<55 岁；n=157）、年轻（55-64 岁；n=284）、年龄较大（65-74 岁；n=355）和老年（≥75 岁；n=407），比较了不同年龄组的临床和超声心动图特征、生活质量和结局，以及非常年轻的 HFpEF 患者与年龄和性别匹配的无心衰对照者之间的差异。
我们 HFpEF 患者人群的 37%年龄<65 岁。年轻与男性为主和更高的肥胖患病率（体重指数≥30kg/m；非常年轻的 HFpEF 中为 36%，老年的为 16%）相关，同时肾功能不全、心房颤动和高血压的患病率较低（均 P<0.001）。非常年轻和老年 HFpEF 的左心室充盈压和左心室肥厚患病率相似。与老年 HFpEF（21%）相比，非常年轻 HFpEF 的生活质量更好，1 年内心脏死亡和心力衰竭住院的发生率更低（P<0.001）。与对照者相比，非常年轻的 HFpEF 的死亡率高 3 倍，且肥厚的患病率高 2 倍。
与年龄较大的 HFpEF 患者相比，年轻和非常年轻的 HFpEF 患者的心脏不良重构相似，与无心衰的对照者相比，预后极差。肥胖可能是年轻和非常年轻 HFpEF 患者中很大一部分 HFpEF 的主要驱动因素。
