H2FPEF 评分作为 HFpEF 患者的预后价值。

H2FPEF Score as a Prognostic Value in HFpEF Patients.

机构信息

Department of Cardiovascular Medicine Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.

Center for Metabolic Regulation of Healthy Aging, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.

出版信息

Am J Hypertens. 2019 Oct 16;32(11):1082-1090. doi: 10.1093/ajh/hpz108.

DOI:10.1093/ajh/hpz108

PMID:31271191

Abstract

BACKGROUND

The H2FPEF score is recognized as a simple method to diagnose heart failure (HF) with preserved left ventricular ejection fraction (HFpEF). We investigated the value of the H2FPEF score in predicting subsequent cardiovascular events in HFpEF patients.

METHODS

This study was a retrospective, single-center, observational study. We calculated the H2FPEF scores for 404 consecutive HFpEF patients. Subjects were subdivided into low- (0-3), intermediate- (4-6), and high-score (7-9) groups and followed for 50 months. The primary and secondary endpoints were composite cardiovascular/cerebrovascular events (cardiovascular death, nonfatal myocardial infarction, unstable angina pectoris, hospitalization for HF decompensation, and nonfatal stroke) occurrence and HF-related events (hospitalization for HF decompensation) occurrence at 50 months, respectively.

RESULTS

Kaplan-Meier analyses demonstrated a significantly higher incidence of cardiovascular/cerebrovascular events among those with a higher H2FPEF score (log-rank test, P = 0.005). The HF-related event rate was higher in proportion to the H2FPEF score (log-rank test, P < 0.001). Multivariate Cox hazard analyses identified the H2FPEF score (per 1 point) as an independent predictor of cardiovascular and HF-related events (hazard ratio [HR], 1.179; 95% confidence interval [CI], 1.066-1.305; P = 0.001 and HR, 1.288; 95% CI, 1.134-1.463; P = 0.001, respectively). Receiver operating characteristic analysis showed that the H2FPEF significantly predicted cardiovascular events (area under the curve [AUC], 0.626; 95% CI, 0.557-0.693; P < 0.001) and HF-related events (AUC, 0.680; 95% CI, 0.600-0.759; P < 0.001). The cutoff H2FPEF score was 5.5 for the identification of cardiovascular and HF-related events.

CONCLUSION

The H2FPEF score might be a potentially useful marker for the prediction of cardiovascular and HF-related events in HFpEF patients.

CLINICAL TRAILS REGISTRATION

Trail Number UMIN000029600.

摘要

背景

H2FPEF 评分被认为是一种诊断射血分数保留的心力衰竭（HFpEF）的简单方法。我们研究了 H2FPEF 评分在预测 HFpEF 患者后续心血管事件中的价值。

方法

本研究为回顾性、单中心、观察性研究。我们为 404 例连续 HFpEF 患者计算了 H2FPEF 评分。受试者分为低（0-3）、中（4-6）和高（7-9）评分组，并随访 50 个月。主要终点和次要终点分别为 50 个月时复合心血管/脑血管事件（心血管死亡、非致死性心肌梗死、不稳定型心绞痛、心力衰竭失代偿住院和非致死性卒中）和心力衰竭相关事件（心力衰竭失代偿住院）的发生。

结果

Kaplan-Meier 分析表明，H2FPEF 评分较高的患者心血管/脑血管事件发生率显著较高（对数秩检验，P=0.005）。心力衰竭相关事件发生率与 H2FPEF 评分呈正相关（对数秩检验，P<0.001）。多变量 Cox 风险分析确定 H2FPEF 评分（每 1 分）是心血管和心力衰竭相关事件的独立预测因素（风险比[HR]，1.179；95%置信区间[CI]，1.066-1.305；P=0.001 和 HR，1.288；95%CI，1.134-1.463；P=0.001）。受试者工作特征曲线分析显示，H2FPEF 显著预测心血管事件（曲线下面积[AUC]，0.626；95%CI，0.557-0.693；P<0.001）和心力衰竭相关事件（AUC，0.680；95%CI，0.600-0.759；P<0.001）。H2FPEF 的截断值为 5.5，用于识别心血管和心力衰竭相关事件。