Howlett Jonathan G, Sharma Nakul, Alemayehu Wendimagegn G, Dyck Jason R B, Anderson Todd, Fine Nowell, Becker Harald, White James A, Paterson D Ian, Thompson Richard B, Oudit Gavin Y, Haykowsky Mark J, Ezekowitz Justin A
Cumming School of Medicine, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada.
Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.
ESC Heart Fail. 2020 Oct;7(5):2725-2733. doi: 10.1002/ehf2.12863. Epub 2020 Jun 27.
The aim of this study is to determine factors associated with long-term recovery of left ventricular ejection fraction (LVEF) in patients with heart failure with reduced EF (HFrEF) and if further recovery also occurs in this group.
Among 621 participants enrolled in the Alberta Heart Failure Etiology and Analysis Team (HEART) Study, 316 with Stage C HF underwent comprehensive imaging and biomarker testing at enrolment and at 1-year follow up. Using pre-enrolment data, HF with recovered EF (HFrecEF) was defined as an absolute improvement ≥5% in LVEF from the prior lowest LVEF value, with a final LVEF value > 35% at or prior to study baseline. Participants with all LVEF > 40% were included for comparison. Hospitalization-free survival to 5 years was performed. The median cohort age was 66 years, and time from diagnosis was 4 years; 82% were male patients. Of the 316 patients, 95 (30%) patients had HFrecEF and 56 (18%) patients pHFrEF. On multivariate analysis, only shorter duration of HF was predictive of HFrecEF status. Over 1 year, LVEF increased in the HFrecEF group 4.0% (0.15-7.90, P = 0.042) as compared with persistent HFrEF, who in turn demonstrated higher baseline serum high sensitivity Troponin-T with further increase at follow up 0.55(0.33-0.86, P = 0.011). No change in any parameter in the HFpEF/HFmrEF group at follow up was observed.
Patients with HFrecEF demonstrate evidence of additional late improvement in LVEF and unchanged troponin levels, in contrast to those with persistent HFrEF, where LVEF does not improve and serum troponin rises over time. These data help to inform mechanisms relating to late LV remodelling.
本研究旨在确定射血分数降低的心力衰竭（HFrEF）患者左心室射血分数（LVEF）长期恢复的相关因素，以及该组患者是否会出现进一步恢复。
在艾伯塔心力衰竭病因与分析团队（HEART）研究纳入的621名参与者中，316名C期心力衰竭患者在入组时和1年随访时接受了全面的影像学和生物标志物检测。利用入组前数据，射血分数恢复的心力衰竭（HFrecEF）定义为LVEF较之前最低LVEF值绝对改善≥5%，且在研究基线或之前最终LVEF值>35%。纳入所有LVEF>40%的参与者进行比较。进行了至5年的无住院生存分析。队列中位年龄为66岁，诊断后时间为4年；82%为男性患者。在316例患者中，95例（30%）患者为HFrecEF，56例（18%）患者为pHFrEF。多因素分析显示，只有心力衰竭持续时间较短可预测HFrecEF状态。1年期间，HFrecEF组LVEF增加4.0%（0.15 - 7.90，P = 0.042），而持续性HFrEF组LVEF无增加，持续性HFrEF组基线血清高敏肌钙蛋白-T较高，随访时进一步升高0.55（0.33 - 0.86，P = 0.011）。随访时未观察到HFpEF/HFmrEF组任何参数有变化。
与持续性HFrEF患者不同，HFrecEF患者显示出LVEF有额外的晚期改善且肌钙蛋白水平无变化，持续性HFrEF患者LVEF无改善且血清肌钙蛋白随时间升高。这些数据有助于阐明与晚期左心室重构相关的机制。
