Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota; Department of Medicine, Section of Cardiology, University of Verona, Verona, Italy.
Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
JACC Heart Fail. 2019 Sep;7(9):808-817. doi: 10.1016/j.jchf.2019.04.024. Epub 2019 Aug 7.
The objective of this study was to determine short- and long-term excess mortality associated with diastolic echocardiographic measures (primarily E/e' ratio) in patients with HF with reduced ejection fraction.
In patients with heart failure (HF), Doppler echocardiography diastolic alterations are frequently but not convincingly linked to survival. Consequently, they are not included in risk-score algorithms or substantially mentioned in HF guidelines.
Consecutive patients with HF Stage B to C, diagnosed between 2003 and 2011, with ejection fraction <50%, Doppler diastolic characterization, complete clinical evaluation, and estimated pulmonary pressure, were analyzed. Outcome measure was mortality under medical management.
The 12,421 eligible patients were 69 ± 14 years of age, 32% were women, 72% had Stage C HF, with ejection fraction 36 ± 10% and E/e' ratio of 17 ± 9. During median follow-up 4.0 (1.1 to 7.0) years, 1-year and 5-year mortality were 17 ± 0.4% and 42 ± 0.5%. E/e' ratio >20 was linked to elevated 1-year mortality (adjusted odds ratio: 1.45 [95% confidence interval (CI): 1.16 to 1.83]; p = 0.001). Long-term E/e' ratios >20 and >14 to 20 were associated with reduced survival (adjusted hazard ratio: 1.21 [95% CI: 1.07 to 1.37]; p = 0.003, and adjusted hazard ratio: 1.15 [95% CI: 1.02 to 1.29]; p = 0.02), independent of all HF characteristics and in all patients' subsets, including HF Stage B and Stage C. Guideline-based diastolic-grade algorithm also independently predicted mortality (p < 0.0001) but was definable less frequently (70%).
In reduced ejection fraction HF, diastolic Doppler alterations entail considerable mortality independent of all presentation characteristics. Elevated E/e' ratio, associated with worse HF at diagnosis, is also, independent of presentation, linked to substantial short-term reduced survival and long-term sustained excess mortality and should be incorporated into HF risk assessment.
本研究旨在确定射血分数降低的心力衰竭患者的舒张超声心动图指标（主要为 E/e' 比值）与短期和长期死亡率之间的关系。
在心力衰竭（HF）患者中，多普勒超声心动图舒张改变虽常见，但并不具有说服力，与生存率相关。因此，这些改变并未被纳入风险评分算法，也未在 HF 指南中得到充分提及。
分析了 2003 年至 2011 年间连续诊断为 HF 阶段 B 至 C 期、射血分数 <50%、多普勒舒张特征、完整临床评估和估计肺动脉压的患者。主要终点是药物治疗下的死亡率。
共有 12421 名符合条件的患者，年龄 69 ± 14 岁，32%为女性，72%为 HF 阶段 C 期，射血分数为 36 ± 10%，E/e' 比值为 17 ± 9。在中位随访 4.0（1.1 至 7.0）年期间，1 年和 5 年死亡率分别为 17 ± 0.4%和 42 ± 0.5%。E/e' 比值>20 与 1 年死亡率升高相关（校正比值比：1.45 [95%置信区间：1.16 至 1.83]；p=0.001）。长期 E/e' 比值>20 和 14 至 20 与生存率降低相关（校正风险比：1.21 [95%置信区间：1.07 至 1.37]；p=0.003，和校正风险比：1.15 [95%置信区间：1.02 至 1.29]；p=0.02），独立于所有 HF 特征，且在所有患者亚组中均成立，包括 HF 阶段 B 和阶段 C。基于指南的舒张分级算法也可独立预测死亡率（p<0.0001），但定义频率较低（70%）。
在射血分数降低的 HF 中，舒张多普勒改变与所有临床表现特征无关，死亡率较高。与诊断时 HF 恶化相关的升高的 E/e' 比值，与临床表现无关，也与短期生存率显著降低和长期持续过度死亡率相关，应纳入 HF 风险评估。
