Guo Pan, Dai Jian-Feng, Feng Chao, Chen Shu-Tao, Feng Jin-Ping
Department of Cardiology, Tianjin Chest Hospital, Tianjin 300222, China.
Graduate School of Medicine, Tianjin Medical University, Tianjin 300070, China.
Chin Med J (Engl). 2020 Feb 20;133(4):452-461. doi: 10.1097/CM9.0000000000000653.
Clinical features and outcomes of heart failure (HF) with mid-range ejection fraction (HFmrEF) remain controversial. Thus, we systematically reviewed literatures of clinical research to assess and analyze characteristics and prognosis of patients with HFmrEF.
PubMed, Embase, and Web of Science were searched for cohort studies up to April 23, 2019. Clinical features and multivariate adjusted hazard ratios (HRs) of endpoints of short-term all-cause mortality (SAM), long-term all-cause mortality (LAM), long-term cardiovascular death (LCD) and long-term HF rehospitalization (LHR) among patients with HFmrEF and HF with preserved ejection fraction (HFpEF), HF with reduced ejection fraction (HFrEF) were well addressed. The primary outcome was LAM.
Totally 19 studies were included in this study with 164,678 patients enrolled. The follow-up time of LAM was 3.6 ± 2.5 years. HRs of LAM, SAM, LCD, LHR indicated that the risks of patients with HFmrEF were higher than HFpEF patients but lower than HFrEF patients, as for LAM, HFmrEF:HFpEF (reference) HR: 1.07, 95% confidence interval (CI): 1.00-1.15 (I = 63%, P = 0.0005); HFmrEF:HFrEF (reference) HR: 0.80, 95% CI: 0.73-0.88 (I = 70%, P < 0.0001). However, HFmrEF patients had the lowest rate in LAM (30.94%), SAM (2.73%), LCD (17.45%), LHR (26.36%) compared with the other two groups.
This systematic review and meta-analysis compared features and prognosis between patients with HFmrEF and HFpEF, HFrEF by HRs. There appeared a special "separation phenomenon" showing rates of endpoints were inconsistent with their hazards in patients with HFmrEF compared with HFpEF patients.
射血分数处于中等范围的心力衰竭（HFmrEF）的临床特征和预后仍存在争议。因此，我们系统回顾了临床研究文献，以评估和分析HFmrEF患者的特征和预后。
检索了PubMed、Embase和Web of Science截至2019年4月23日的队列研究。详细阐述了HFmrEF患者以及射血分数保留的心力衰竭（HFpEF）患者、射血分数降低的心力衰竭（HFrEF）患者的短期全因死亡率（SAM）、长期全因死亡率（LAM）、长期心血管死亡（LCD）和长期心力衰竭再住院率（LHR）的临床特征及多变量调整后的风险比（HRs）。主要结局为LAM。
本研究共纳入19项研究，纳入患者164,678例。LAM的随访时间为3.6±2.5年。LAM、SAM、LCD、LHR的HRs表明，HFmrEF患者的风险高于HFpEF患者，但低于HFrEF患者，就LAM而言，HFmrEF:HFpEF（对照）HR：1.07，95%置信区间（CI）：1.00 - 1.15（I = 63%，P = 0.0005）；HFmrEF:HFrEF（对照）HR：0.80，95%CI：0.73 - 0.88（I = 70%，P < 0.0001）。然而，与其他两组相比，HFmrEF患者的LAM（30.94%）、SAM（2.73%）、LCD（17.45%）、LHR（26.36%）发生率最低。
本系统评价和荟萃分析通过HRs比较了HFmrEF患者与HFpEF、HFrEF患者的特征和预后。出现了一种特殊的“分离现象”，即与HFpEF患者相比，HFmrEF患者的终点发生率与其风险不一致。
