事件性心力衰竭与静脉血栓栓塞的长期风险。
Incident Heart Failure and Long-Term Risk for Venous Thromboembolism.
机构信息
Division of Cardiovascular Medicine, University of Minnesota Medical Center, Minneapolis, Minnesota.
Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota.
出版信息
J Am Coll Cardiol. 2020 Jan 21;75(2):148-158. doi: 10.1016/j.jacc.2019.10.058.
BACKGROUND
Heart failure (HF) hospitalization places patients at increased short-term risk for venous thromboembolism (VTE). Long-term risk for VTE associated with incident HF, HF subtypes, or structural heart disease is unknown.
OBJECTIVES
In the ARIC (Atherosclerosis Risk In Communities) cohort, VTE risk associated with incident HF, HF subtypes, and abnormal echocardiographic measures in the absence of clinical HF was assessed.
METHODS
During follow-up, ARIC identified incident HF and subcategorized HF with preserved ejection fraction or reduced ejection fraction. At the fifth clinical examination, echocardiography was performed. Physicians adjudicated incident VTE using hospital records. Adjusted Cox proportional hazards models were used to evaluate the association between HF or echocardiographic exposures and VTE.
RESULTS
Over a mean of 22 years in 13,728 subjects, of whom 2,696 (20%) developed incident HF, 729 subsequent VTE events were identified. HF was associated with increased long-term risk for VTE (adjusted hazard ratio: 3.13; 95% confidence interval: 2.58 to 3.80). In 7,588 subjects followed for a mean of 10 years, the risk for VTE was similar for HF with preserved ejection fraction (adjusted hazard ratio: 4.71; 95% CI: 2.94 to 7.52) and HF with reduced ejection fraction (adjusted hazard ratio: 5.53; 95% confidence interval: 3.42 to 8.94). In 5,438 subjects without HF followed for a mean of 3.5 years, left ventricular relative wall thickness and mean left ventricular wall thickness were independent predictors of VTE.
CONCLUSIONS
In this prospective population-based study, incident hospitalized HF (including both heart failure with preserved ejection fraction and reduced ejection fraction), as well as echocardiographic indicators of left ventricular remodeling, were associated with greatly increased risk for VTE, which persisted through long-term follow-up. Evidence-based strategies to prevent long-term VTE in patients with HF, beyond time of hospitalization, are needed.
背景
心力衰竭（HF）住院会使患者在短期内增加静脉血栓栓塞（VTE）的风险。与新发 HF、HF 亚型或结构性心脏病相关的 VTE 长期风险尚不清楚。
目的
在 ARIC（社区动脉粥样硬化风险）队列中，评估了新发 HF、HF 亚型以及在没有临床 HF 的情况下异常超声心动图指标与 VTE 风险的关系。
方法
在随访期间，ARIC 确定了新发 HF，并根据射血分数保留或射血分数降低对 HF 进行分类。在第五次临床检查时进行了超声心动图检查。医生使用住院记录来确定新发 VTE。采用调整后的 Cox 比例风险模型评估 HF 或超声心动图暴露与 VTE 之间的关联。
结果
在 13728 名受试者中，平均随访 22 年，其中 2696 名（20%）发生新发 HF，随后确定了 729 例 VTE 事件。HF 与 VTE 的长期风险增加相关（调整后的风险比：3.13；95%置信区间：2.58 至 3.80）。在平均随访 10 年的 7588 名受试者中，射血分数保留型 HF（调整后的风险比：4.71；95%置信区间：2.94 至 7.52）和射血分数降低型 HF（调整后的风险比：5.53；95%置信区间：3.42 至 8.94）的 VTE 风险相似。在平均无 HF 随访 3.5 年的 5438 名受试者中，左心室相对壁厚度和左心室平均壁厚度是 VTE 的独立预测因子。
结论
在这项前瞻性基于人群的研究中，新发住院 HF（包括射血分数保留型和射血分数降低型 HF）以及左心室重构的超声心动图指标与 VTE 的风险显著增加相关，这种相关性在长期随访中持续存在。需要针对 HF 患者，在住院时间以外，制定预防长期 VTE 的循证策略。
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