临床前心力衰竭的进展：社区人群中 A 期和 B 期心力衰竭的描述。
Progression of Preclinical Heart Failure: A Description of Stage A and B Heart Failure in a Community Population.
机构信息
Department of Cardiovascular Diseases (K.A.Y., R.J.R., H.H.C.), Mayo Clinic, Rochester, MN.
Division of Biomedical Statistics and Informatics (C.G.S.), Mayo Clinic, Rochester, MN.
出版信息
Circ Cardiovasc Qual Outcomes. 2021 May;14(5):e007216. doi: 10.1161/CIRCOUTCOMES.120.007216. Epub 2021 May 6.
BACKGROUND
The aims of this study are to evaluate the rate of progression of preclinical (Stage A and B) heart failure, identify associated characteristics, and evaluate long-term outcomes.
METHODS
Retrospective review of the Olmsted County Heart Function Study. Individuals categorized as Stage A or B heart failure at initial visit that returned for a second visit 4 years later were included. Logistic regression analyses evaluated group differences with adjustment for age and sex.
RESULTS
At visit 1, 413 (32%) individuals were classified as Stage A and 413 (32%) as Stage B. By visit 2, 146 (35%) individuals from Stage A progressed with the vast majority (n=142) progressing to Stage B. In comparison, a total of 23 (6%) individuals progressed from Stage B. A greater rate of progression was seen for Stage A compared with Stage B (8.7 per 100 person-years [95% CI, 7.4-10.2] versus 1.4 per 100 person-years [95% CI, 0.9-2.1]; <0.001). NT-proBNP correlated with progression for Stage B (=0.01), but not for Stage A (=0.39). A multivariate model found female sex (odds ratio, 1.65 [95% CI, 1.05-2.58]; =0.03), increased E/e' (odds ratio, 1.13 [95% CI, 1.02-1.26], =0.02), and beta blocker use (odds ratio, 2.19 [95% CI, 1.25-3.82], =0.006) were associated with progression for Stage A. There was a signal that cardiovascular mortality was higher in individuals who progressed, although not statistically significant (=0.06 for Stage A and =0.05 for Stage B).
CONCLUSIONS
There is significant progression of preclinical heart failure in a community population, with progression rates higher for Stage A. NT-proBNP correlated with progression for Stage B, but not for Stage A. No statistically significant differences in long-term outcomes were seen. Study results have clinical implications important to help guide future heart failure screening and prevention strategies.
背景
本研究旨在评估临床前期（A 期和 B 期）心力衰竭的进展率，确定相关特征，并评估长期结局。
方法
回顾性分析奥姆斯特德县心脏功能研究。在最初就诊时被归类为 A 期或 B 期心力衰竭且在 4 年后返回第二次就诊的患者被纳入研究。采用逻辑回归分析评估组间差异，并进行年龄和性别调整。
结果
在第 1 次就诊时，413 例（32%）患者被归类为 A 期，413 例（32%）患者被归类为 B 期。在第 2 次就诊时，A 期中有 146 例（35%）患者病情进展，其中绝大多数（n=142）进展为 B 期。相比之下，B 期仅有 23 例（6%）患者进展。与 B 期相比，A 期的进展速度更快（每 100 人年 8.7 例[95%CI，7.4-10.2]与每 100 人年 1.4 例[95%CI，0.9-2.1]；<0.001）。NT-proBNP 与 B 期进展相关（=0.01），但与 A 期进展无关（=0.39）。多变量模型发现女性性别（优势比，1.65[95%CI，1.05-2.58]；=0.03）、E/e'增加（优势比，1.13[95%CI，1.02-1.26]；=0.02）和β受体阻滞剂的使用（优势比，2.19[95%CI，1.25-3.82]；=0.006）与 A 期进展相关。尽管没有统计学意义（A 期为=0.06，B 期为=0.05），但有信号表明进展患者的心血管死亡率更高。
结论
在社区人群中，临床前期心力衰竭有显著进展，A 期的进展率更高。NT-proBNP 与 B 期进展相关，但与 A 期进展无关。长期结局没有统计学上的显著差异。研究结果对指导未来心力衰竭的筛查和预防策略具有重要的临床意义。
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