Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Clin Res Cardiol. 2019 Dec;108(12):1394-1405. doi: 10.1007/s00392-019-01477-z. Epub 2019 Apr 12.
HFmrEF has been recently proposed as a distinct HF phenotype. How HFmrEF differs from HFrEF and HFpEF according to age remains poorly defined. We aimed to investigate age-dependent differences in heart failure with mid-range (HFmrEF) vs. preserved (HFpEF) and reduced (HFrEF) ejection fraction.
42,987 patients, 23% with HFpEF, 22% with HFmrEF and 55% with HFrEF, enrolled in the Swedish heart failure registry were studied. HFpEF prevalence strongly increased, whereas that of HFrEF strongly decreased with higher age. All cardiac comorbidities and most non-cardiac comorbidities increased with aging, regardless of the HF phenotype. Notably, HFmrEF resembled HFrEF for ischemic heart disease prevalence in all age groups, whereas regarding hypertension it was more similar to HFpEF in age ≥ 80 years, to HFrEF in age < 65 years and intermediate in age 65-80 years. All-cause mortality risk was higher in HFrEF vs. HFmrEF for all age categories, whereas HFmrEF vs. HFpEF reported similar risk in ≥ 80 years old patients and lower risk in < 65 and 65-80 years old patients. Predictors of mortality were more likely cardiac comorbidities in HFrEF but more likely non-cardiac comorbidities in HFpEF and HFmrEF with < 65 years. Differences among HF phenotypes for comorbidities were less pronounced in the other age categories.
HFmrEF appeared as an intermediate phenotype between HFpEF and HFrEF, but for some characteristics such as ischemic heart disease more similar to HFrEF. With aging, HFmrEF resembled more HFpEF. Prognosis was similar in HFmrEF vs. HFpEF and better than in HFrEF.
HFmrEF 最近被提出为一种独特的 HF 表型。HFmrEF 与 HFrEF 和 HFpEF 根据年龄的差异仍未得到很好的定义。我们旨在研究射血分数中间值心力衰竭（HFmrEF）与保留（HFpEF）和降低（HFrEF）之间与年龄相关的差异。
在瑞典心力衰竭注册中心登记的 42987 名患者中，有 23%患有 HFpEF，22%患有 HFmrEF，55%患有 HFrEF。HFpEF 的患病率随着年龄的增加而显著增加，而 HFrEF 的患病率则显著降低。无论 HF 表型如何，所有心脏合并症和大多数非心脏合并症都会随着年龄的增长而增加。值得注意的是，HFmrEF 在所有年龄段的缺血性心脏病患病率方面与 HFrEF 相似，而在高血压方面，在年龄≥80 岁时与 HFpEF 更相似，在年龄<65 岁时与 HFrEF 更相似，在 65-80 岁时则处于中间水平。在所有年龄段中，全因死亡率风险在 HFrEF 中均高于 HFmrEF，而在年龄≥80 岁的患者中，HFmrEF 与 HFpEF 的风险相似，在年龄<65 岁和 65-80 岁的患者中风险较低。死亡的预测因素在 HFrEF 中更可能是心脏合并症，但在 HFpEF 和 HFmrEF 中更可能是非心脏合并症，而在年龄<65 岁的患者中则较少。在其他年龄组中，HF 表型之间的合并症差异不太明显。
HFmrEF 似乎是 HFpEF 和 HFrEF 之间的中间表型，但在某些特征方面，如缺血性心脏病，与 HFrEF 更相似。随着年龄的增长，HFmrEF 更类似于 HFpEF。HFmrEF 的预后与 HFpEF 相似，优于 HFrEF。
