Department of Cardiovascular Medicine, Yao Municipal Hospital, Yao, Osaka, Japan
Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
Open Heart. 2020 Dec;7(2). doi: 10.1136/openhrt-2020-001469.
During follow-up time, the value of prognostic factors may change, especially in the elderly patients, and the altered extent may affect the prognosis. We aimed to clarify the significance of the ratio of diastolic elastance (Ed) to arterial elastance (Ea), (Ed/Ea=(E/e')/(0.9×systolic blood pressure)), an afterload-integrated diastolic index, in relation to follow-up periods and other laboratory factors, on the prognosis of elderly patients with heart failure with preserved ejection fraction (HFpEF).
We studied 552 HFpEF patients hospitalised for acute decompensated heart failure (men/women: 255/297). Blood testing and transthoracic echocardiography were performed before discharge. The primary endpoint was all-cause mortality.
During a median follow-up of 508 days, 88 patients (men/women: 39/49) had all-cause mortality. During the first year after discharge, Ed/Ea (p=0.045) was an independent prognostic factor in association with albumin (p<0.001) and N-terminal pro-brain natriuretic peptide (NT-proBNP, p=0.005) levels after adjusting for age and sex in the multivariate Cox hazard analysis. However, at 1 to 3 years after discharge, no other significant prognostic factors, except for albumin level (p=0.046), were detected. In the subgroup analysis, albumin, but not NT-proBNP level, showed a significant interaction with Ed/Ea for prognosis (p=0.047).
The prognostic significance of a haemodynamic parameter such as Ed/Ea may be valid only during a short-term period, but that of albumin was persisting during the entire follow-up period in the elderly patients. The clinical significance of prognostic factors in HFpEF patients may differ according to the follow-up period.
在随访期间，预后因素的价值可能会发生变化，尤其是在老年患者中，改变的程度可能会影响预后。我们旨在阐明舒张弹性（Ed）与动脉弹性（Ea）之比（Ed/Ea=（E/e'）/（0.9×收缩压），一个整合了后负荷的舒张指数）与随访时间和其他实验室因素之间的关系，对射血分数保留的心力衰竭（HFpEF）老年患者的预后的意义。
我们研究了 552 名因急性失代偿性心力衰竭住院的 HFpEF 患者（男性/女性：255/297）。在出院前进行了血液检测和经胸超声心动图检查。主要终点是全因死亡率。
在中位数为 508 天的随访期间，88 名患者（男性/女性：39/49）发生了全因死亡。在出院后第一年，Ed/Ea（p=0.045）是一个独立的预后因素，与白蛋白（p<0.001）和 N 末端脑利钠肽前体（NT-proBNP，p=0.005）水平相关，在多变量 Cox 风险分析中调整了年龄和性别。然而，在出院后 1 至 3 年，除了白蛋白水平（p=0.046）外，没有发现其他显著的预后因素。在亚组分析中，白蛋白，而不是 NT-proBNP 水平，与 Ed/Ea 对预后的交互作用具有显著意义（p=0.047）。
Ed/Ea 等血流动力学参数的预后意义可能仅在短期时间内有效，但白蛋白的预后意义在老年患者的整个随访期间都持续存在。HFpEF 患者预后因素的临床意义可能因随访时间而异。
