Liu Feng, Zhang Han, Li Yanming, Lu Xueli
Department of Intensive Care Unit, Huaihe Hospital of Henan University, Kaifeng, China.
Department of Cardiology, Huaihe Hospital of Henan University, Kaifeng, China.
Eur J Clin Invest. 2020 May 6:e13261. doi: 10.1111/eci.13261.
Potential pathophysiology of heart failure with preserved ejection fraction (HFpEF) has not been fully explored. The aim of the study was to reveal the association of serum calcium concentration at baseline with 12-month clinical outcome in the disease.
A total of 350 patients with newly diagnosed HFpEF were included in this prospective observational study. There were no malignant tumour, kidney disease, thyroid disease, calcium and vitamin D supplements in the patients. All of them received 12-month follow-up, and endpoints were cardiac re-hospitalization and death. Baseline serum calcium concentration was measured using AIA2000ST enzyme immunoassay analyser. Cardiopulmonary exercise, six-minute walk distance test, EQ5D questionnaire and cardiac ultrasound were performed to evaluate exercise capacity, quality of life and left ventricle function.
Multivariate COX regression analysis revealed that baseline hypocalcaemia was associated with the increased risk of cardiac re-hospitalization and death during the follow-up period (HR: 2.10, 95% CI: 1.69-2.61; HR: 8.26, 95% CI: 2.88-23.70). Furthermore, baseline hypocalcaemia was related to the deterioration of 6-minute walk distance, quality of life score (EQ-5D), right quadriceps strength, left atrium volume index and left ventricular ejection fraction during the follow-up period (HR: 1.65, 95% CI: 1.21-2.26; HR: 1.55, 95% CI: 1.12-2.11; HR: 2.56, 95% CI: 1.68-3.89; HR: 1.44, 95% CI: 1.03-1.98; HR: 1.36, 95% CI: 1.02-1.80).
Baseline hypocalcaemia predicted 12-month cardiac re-hospitalization and death in HFpEF patients without calcium and vitamin D supplements partly through left ventricle and skeletal muscle function pathways.
射血分数保留的心力衰竭（HFpEF）的潜在病理生理学尚未得到充分研究。本研究的目的是揭示该疾病患者基线血清钙浓度与12个月临床结局之间的关联。
本前瞻性观察性研究共纳入350例新诊断的HFpEF患者。患者均无恶性肿瘤、肾脏疾病、甲状腺疾病，未服用钙和维生素D补充剂。所有患者均接受了12个月的随访，终点为心脏再住院和死亡。使用AIA2000ST酶免疫分析仪测量基线血清钙浓度。进行心肺运动、六分钟步行距离测试、EQ5D问卷和心脏超声检查以评估运动能力、生活质量和左心室功能。
多因素COX回归分析显示，基线低钙血症与随访期间心脏再住院和死亡风险增加相关（风险比：2.10，95%置信区间：1.69 - 2.61；风险比：8.26，95%置信区间：2.88 - 23.70）。此外，基线低钙血症与随访期间六分钟步行距离、生活质量评分（EQ - 5D）、右股四头肌力量、左心房容积指数和左心室射血分数的恶化相关（风险比：1.65，95%置信区间：1.21 - 2.26；风险比：1.55，95%置信区间：1.12 - 2.11；风险比：2.56，95%置信区间：1.68 - 3.89；风险比：1.44，95%置信区间：1.03 - 1.98；风险比：1.36，95%置信区间：1.02 - 1.80）。
基线低钙血症部分通过左心室和骨骼肌功能途径预测了未服用钙和维生素D补充剂的HFpEF患者12个月的心脏再住院和死亡情况。
