Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
Division of Cardiology, Duke University, Durham, NC, USA.
Eur J Heart Fail. 2020 Jun;22(6):1009-1018. doi: 10.1002/ejhf.1788. Epub 2020 Mar 9.
Patient-reported quality of life (QOL) is a highly prognostic and clinically relevant endpoint in patients with heart failure (HF) with preserved ejection fraction (HFpEF). The relationships between QOL and different markers of HF severity remain unclear, particularly as they relate to functional capacity and directly measured activity levels. We hypothesized that QOL would demonstrate a stronger relationship with measures of exercise capacity and adiposity compared to other disease measures.
This is a secondary analysis of the National Heart, Lung, and Blood Institute-sponsored RELAX, NEAT-HFpEF and INDIE-HFpEF trials to determine the relationships between QOL (assessed by the Kansas City Cardiomyopathy Questionnaire and Minnesota Living with Heart Failure Questionnaire) and different domains reflecting HF severity, including maximal aerobic capacity (peak oxygen consumption), submaximal exercise capacity (6-min walk distance), volume of daily activity (accelerometry), physician-estimated functional class, resting echocardiography, and plasma natriuretic peptide levels. A total of 408 unique patients with chronic HFpEF were split into tertiles of QOL scores defined as QOL QOL , QOL . The QOL HFpEF group was youngest, with a higher body mass index, greater prevalence of class II obesity and diabetes, and the lowest N-terminal pro-brain natriuretic peptide (NT-proBNP) levels. After adjustment for age, sex and body mass index, poorer QOL was associated with worse physical capacity and activity levels, assessed by peak oxygen consumption, 6-min walk distance and actigraphy, but was not associated with NT-proBNP or indices from resting echocardiography. QOL was similarly reduced in patients with and without prior HF hospitalization.
Quality of life in HFpEF is poorest in patients who are young, obese and have diabetes, and is more robustly tied to measures reflecting functional capacity and daily activity levels rather than elevations in NT-proBNP or prior HF hospitalization. These findings have major implications for the understanding of QOL in HFpEF and for the design of future clinical trials targeting symptom improvement in HFpEF.
RELAX, NCT00763867; NEAT-HFpEF, NCT02053493; INDIE-HFpEF, NCT02742129.
患者报告的生活质量（QOL）是射血分数保留的心力衰竭（HFpEF）患者预后和临床相关的重要终点。生活质量与心力衰竭严重程度的不同标志物之间的关系仍不清楚，特别是与功能能力和直接测量的活动水平有关。我们假设与其他疾病指标相比，生活质量与运动能力和肥胖的测量指标具有更强的相关性。
这是国家心肺血液研究所赞助的 RELAX、NEAT-HFpEF 和 INDIE-HFpEF 试验的二次分析，以确定生活质量（通过堪萨斯城心肌病问卷和明尼苏达州心力衰竭生活质量问卷评估）与反映心力衰竭严重程度的不同领域之间的关系，包括最大有氧能力（峰值耗氧量）、亚最大运动能力（6 分钟步行距离）、日常活动量（加速度计）、医生估计的功能分级、静息超声心动图和血浆利钠肽水平。共有 408 名患有慢性 HFpEF 的独特患者被分为生活质量评分的三分位数，定义为生活质量 QOL QOL 和 QOL 。HFpEF 组患者最年轻，体重指数较高，II 级肥胖和糖尿病的患病率较高，N 端脑利钠肽前体（NT-proBNP）水平最低。调整年龄、性别和体重指数后，较差的生活质量与峰值耗氧量、6 分钟步行距离和活动记录仪评估的身体能力和活动水平较差相关，但与 NT-proBNP 或静息超声心动图指数无关。有或没有既往心力衰竭住院史的患者生活质量均降低。
HFpEF 患者的生活质量最差，这些患者年轻、肥胖且患有糖尿病，与反映功能能力和日常活动水平的测量指标更密切相关，而与 NT-proBNP 或既往心力衰竭住院史无关。这些发现对理解 HFpEF 中的生活质量以及为改善 HFpEF 症状而设计未来临床试验具有重要意义。
RELAX，NCT00763867；NEAT-HFpEF，NCT02053493；INDIE-HFpEF，NCT02742129。
