射血分数改善的心力衰竭的频率、预测因素和预后：单中心回顾性观察队列研究。

Frequency, predictors, and prognosis of heart failure with improved left ventricular ejection fraction: a single-centre retrospective observational cohort study.

机构信息

The Fuwai Yunnan Cardiovascular Hospital, Department of Arrhythmia, Kunming Medical University, The No. 528# of North Shahe Road, Kunming, 650032, China.

出版信息

ESC Heart Fail. 2021 Aug;8(4):2755-2764. doi: 10.1002/ehf2.13345. Epub 2021 May 1.

AIMS

An improved left ventricular ejection fraction (HFiEF) was observed across heart failure (HF) patients with a reduced or mid-range ejection fraction (HFrEF or HFmrEF, respectively). We postulated that HFiEF patients are clinically distinct from non-HFiEF patients.

METHODS AND RESULTS

A total of 447 patients hospitalized due to a clinical diagnosis of HF (LVEF <50% at baseline) were enrolled from September 2017 to September 2019. Echocardiogram re-evaluation was conducted repeatedly over 6 months of follow-up after discharge. The primary endpoint included the composite of HF hospitalization and all-cause mortality. Subjects (n = 184) with HFiEF (defined as an absolute LVEF improvement≥10%) were compared with 263 non-HFiEF (defined by <10% improvement in LVEF) subjects. Multivariable Cox regression was performed and identified younger age, smaller left ventricular end diastolic dimension (LVEDD), beta-blocker use, AF ablation and cardiac resynchronization therapy (CRT) as independent predictors of HFiEF. According to Kaplan-Meier analysis, HFiEF subjects had lower cardiac composite outcomes (P = 0.002) and all-cause mortality (P = 0.003) than non-HFiEF subjects. Multivariate Cox survival analysis revealed that non-HFiEF (compared with HFiEF) was an independent predictor of both the primary endpoints (HR = 0.679, 95% CI: 0.451-0.907, P = 0.012), which was driven by all-cause mortality (HR = 0.504, 95% CI: 0.256-0.991, P = 0.047).

CONCLUSIONS

These data confirm that compared with non-HFiEF, HFiEF is a distinct HF phenotype with favourable clinical outcomes.

目的

射血分数降低型心力衰竭（HFrEF）和射血分数中间值型心力衰竭（HFmrEF）患者的左心室射血分数（LVEF）均有改善，而射血分数改善型心力衰竭（HFiEF）患者的 LVEF 改善更为显著。我们推测 HFiEF 患者的临床特征与非 HFiEF 患者不同。

方法和结果

本研究共纳入了 447 名因临床诊断为心力衰竭（HF）而住院的患者（基线 LVEF<50%），这些患者于 2017 年 9 月至 2019 年 9 月期间入院，在出院后 6 个月的随访期间反复进行超声心动图复查。主要终点包括 HF 住院和全因死亡率的复合终点。HFiEF 组（定义为 LVEF 绝对改善≥10%）的患者（n=184）与非 HFiEF 组（定义为 LVEF 改善<10%）的患者（n=263）进行比较。多变量 Cox 回归分析确定了年龄较小、左心室舒张末期内径（LVEDD）较小、β受体阻滞剂的使用、心房颤动消融和心脏再同步治疗（CRT）为 HFiEF 的独立预测因素。根据 Kaplan-Meier 分析，HFiEF 患者的心脏复合终点事件（P=0.002）和全因死亡率（P=0.003）均低于非 HFiEF 患者。多变量 Cox 生存分析显示，非 HFiEF（与 HFiEF 相比）是主要终点的独立预测因素（HR=0.679，95%CI：0.451-0.907，P=0.012），这主要归因于全因死亡率（HR=0.504，95%CI：0.256-0.991，P=0.047）。