Department of Medicine, Karolinska Institutet and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.
Department of Medical Sciences, Uppsala University and Uppsala Clinical Research Center, Uppsala, Sweden; Boehringer Ingelheim AB, Stockholm, Sweden.
JACC Heart Fail. 2019 Apr;7(4):306-317. doi: 10.1016/j.jchf.2018.11.019. Epub 2019 Mar 6.
This study sought to evaluate the incidence, the predictors, and the associations with outcomes of changes in ejection fraction (EF) in heart failure (HF) patients.
EF determines therapy in HF, but information is scarce about incidence, determinants, and prognostic implications of EF change over time.
Patients with ≥2 EF measurements were made in the Swedish Heart Failure Registry were categorized as heart failure with preserved ejection fraction (HFpEF) (EF ≥50%), heart failure with midrange ejection fraction (HFmrEF) (EF 40% to 49%), or heart failure with reduced ejection fraction (HFrEF) (EF <40%). Changes among categories were recorded, and associations among EF changes, predictors, and all-cause mortality and/or HF hospitalizations were analyzed using logistic and Cox regressions.
Of 4,942 patients at baseline, 18% had HFpEF, 19% had HFmrEF, and 63% had HFrEF. During follow-up, 21% and 18% of HFpEF patients transitioned to HFmrEF and HFrEF, respectively; 37% and 25% of HFmrEF patients transitioned to HFrEF and HFpEF, respectively; and 16% and 10% of HFrEF patients transitioned to HFmrEF and HFpEF, respectively. Predictors of increased EF included female sex, cases of less severe HF, and comorbidities. Predictors of decreased EF included diabetes, ischemic heart disease, and cases of more severe HF. Use of renin-angiotensin-system inhibitors was associated with lower likelihood of EF increase, but not with EF decrease, i.e., stable EF. Increased EF was associated with a lower risk (hazard ratio [HR]: 0.62; 95% confidence interval [CI]: 0.55 to 0.69) and decreased EF with a higher risk (HR: 1.15; 95% CI: 1.01 to 1.30) of mortality and/or HF hospitalizations. Prognostic implications were most evident for transitions to and from HFrEF.
Increases in EF occurred in one-fourth of HFrEF and HFmrEF patients, and decreases occurred in more than one-third of patients with HFpEF and HFmrEF. EF change was associated with a wide range of important clinical and organizational factors as well as with outcomes, particularly transitions to and from HFrEF.
本研究旨在评估心力衰竭（HF）患者射血分数（EF）变化的发生率、预测因素及其与结局的关系。
EF 决定了 HF 的治疗，但关于 EF 随时间变化的发生率、决定因素和预后意义的信息很少。
在瑞典心力衰竭注册中心进行了至少两次 EF 测量的患者被分为射血分数保留型心力衰竭（HFpEF）（EF≥50%）、射血分数中间范围型心力衰竭（HFmrEF）（EF 为 40%至 49%）或射血分数降低型心力衰竭（HFrEF）（EF＜40%）。记录类别之间的变化，并使用逻辑回归和 Cox 回归分析 EF 变化、预测因素与全因死亡率和/或 HF 住院之间的关系。
在基线时的 4942 名患者中，18%为 HFpEF，19%为 HFmrEF，63%为 HFrEF。在随访期间，分别有 21%和 18%的 HFpEF 患者转为 HFmrEF 和 HFrEF，37%和 25%的 HFmrEF 患者转为 HFrEF 和 HFpEF，16%和 10%的 HFrEF 患者转为 HFmrEF 和 HFpEF。EF 增加的预测因素包括女性、HF 严重程度较低的病例和合并症。EF 降低的预测因素包括糖尿病、缺血性心脏病和 HF 严重程度较高的病例。肾素-血管紧张素系统抑制剂的使用与 EF 增加的可能性降低相关，但与 EF 降低无关，即 EF 稳定。EF 增加与死亡率和/或 HF 住院的风险降低相关（风险比[HR]：0.62；95%置信区间[CI]：0.55 至 0.69），EF 降低与风险增加相关（HR：1.15；95% CI：1.01 至 1.30）。从 HFrEF 转为 HFpEF 和 HFmrEF 的患者，EF 变化的预后意义最为明显。
在 HFrEF 和 HFmrEF 患者中，有四分之一的患者 EF 增加，而 HFpEF 和 HFmrEF 患者中有三分之一以上的患者 EF 降低。EF 变化与广泛的重要临床和组织因素以及结局相关，特别是与从 HFrEF 转为 HFpEF 和 HFmrEF。
