Division of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Gumiro 166, Bundang, Seongnam, Gyeonggi-do, Republic of Korea.
Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea.
Clin Res Cardiol. 2020 Feb;109(2):225-234. doi: 10.1007/s00392-019-01505-y. Epub 2019 Jul 2.
Some patients with heart failure with preserved ejection fraction (HFpEF) experience declining of left-ventricular ejection fraction (LVEF) during follow-up. We aim to investigate the characteristics and outcomes of patients with HF with declining ejection fraction (HFdEF).
We analyzed a prospective, nationwide multicenter cohort with consecutive patients with acute HF enrolled from March 2011 to December 2014. HFpEF was defined as LVEF ≥ 50% at index admission. After 1 year, HFpEF patients were further classified as HFdEF (LVEF ≥ 50% at admission and < 50% at 1 year), and persistent HFpEF (LVEF ≥ 50% both at admission and 1 year). Primary outcome was 4-year all-cause mortality according to HF type from HFdEF diagnosis.
Of patients with HFpEF, 426 (90.4%) were diagnosed as having persistent HFpEF and 45 (9.6%) as having HFdEF. Natriuretic peptide level was an independent predictor of HFdEF (natriuretic peptide level > median: odds ratio: 3.20, 95% confidence interval [CI]: 1.42-7.25, P = 0.005). During 4-year follow-up, patients with HFdEF had higher mortality than those with persistent HFpEF (Log-rank P < 0.001). After adjustment, HFdEF was associated with an almost twofold increased risk for mortality (hazard ratio 1.82, 95% CI 1.13-2.96, P = 0.015). The use of beta-blockers, renin-angiotensin system inhibitors, and mineralocorticoid receptor antagonists was not associated with improved prognosis of patients with HFdEF.
HFdEF is a distinct HF type with grave outcomes. Further investigations that focus on HFdEF are warranted to better understand and develop treatment strategies for these high-risk patients.
ClinicalTrial.gov identifier: NCT01389843. URL: https://clinicaltrials.gov/ct2/show/NCT01389843.
一些射血分数保留的心力衰竭（HFpEF）患者在随访期间出现左心室射血分数（LVEF）下降。本研究旨在探讨射血分数下降的心力衰竭（HFdEF）患者的特征和结局。
我们分析了一项前瞻性、全国性多中心队列研究，该研究纳入了 2011 年 3 月至 2014 年 12 月期间连续收治的急性心力衰竭患者。HFpEF 的定义为入院时 LVEF≥50%。1 年后，HFpEF 患者进一步分为 HFdEF（入院时 LVEF≥50%，1 年后<50%）和持续性 HFpEF（入院时和 1 年后 LVEF≥50%）。主要结局是根据 HFdEF 诊断，HFdEF 患者的 4 年全因死亡率。
HFpEF 患者中，426 例（90.4%）诊断为持续性 HFpEF，45 例（9.6%）诊断为 HFdEF。利钠肽水平是 HFdEF 的独立预测因素（利钠肽水平>中位数：比值比 3.20，95%置信区间 [CI]：1.42-7.25，P=0.005）。在 4 年随访期间，HFdEF 患者的死亡率高于持续性 HFpEF 患者（Log-rank P<0.001）。调整后，HFdEF 患者的死亡风险几乎增加了两倍（风险比 1.82，95%CI 1.13-2.96，P=0.015）。β受体阻滞剂、肾素-血管紧张素系统抑制剂和盐皮质激素受体拮抗剂的使用与 HFdEF 患者的预后改善无关。
HFdEF 是一种具有严重结局的心力衰竭新类型。需要进一步研究 HFdEF，以更好地了解和制定这些高危患者的治疗策略。
ClinicalTrials.gov 标识符：NCT01389843。网址：https://clinicaltrials.gov/ct2/show/NCT01389843。
