Duke Clinical Research Institute, Duke University, Durham, NC; Duke University Hospital, Duke University, Durham, NC.
Duke Clinical Research Institute, Duke University, Durham, NC.
Am Heart J. 2022 Mar;245:110-116. doi: 10.1016/j.ahj.2021.12.003. Epub 2021 Dec 18.
Recent data suggest that patients with heart failure with reduced ejection fraction (HFrEF) and worsening heart failure (WHF) have potential for greater benefit from newer HF therapies. We investigated characteristics and outcomes of patients with HFrEF and WHF by severity of left ventricular dysfunction.
We identified patients with chronic symptomatic HFrEF (left ventricular ejection fraction [LVEF] ≤35%) and evidence of WHF (emergency department visit or hospitalization for acute HF within 12 months of index echocardiogram) treated at Duke University between 1/2009 and 12/2018. Patients were stratified by LVEF≤25% or 26% to35%. Cox models were used to estimate cause-specific hazard ratios and 5-year event incidence of death and hospitalization across the range of LVEF.
Of 2823 patients with HFrEF and WHF, 1620 (57.4%) had an LVEF≤25% and 1203 (42.6%) had an LVEF 26% to35%. Compared to patients with LVEF 26% to35%, those with LVEF≤25% were younger and more commonly men with a lower cardiovascular comorbidity burden. Patients with LVEF≤25% were less commonly on beta blockers (85.9% vs 90.5%) but more commonly treated with mineralocorticoid receptor antagonists (49.3% vs 41.1%) and implantable defibrillators (41.3% vs 28.2%). Patients with LVEF≤25% had significantly higher hazards for death (HR 1.24 [95% CI 1.11 - 1.38]), all-cause hospitalization (HR 1.21 [95% CI 1.10 - 1.33]), and HF hospitalization (HR 1.25 [95% CI 1.1 - 1.38]) through 5-years.
More than half of patients with chronic HFrEF and WHF have severe LV dysfunction. Important differences in comorbidities, HF therapies, and outcomes exist between those with LVEF≤25% and those with LVEF 26% to35%.
最近的数据表明，射血分数降低的心力衰竭（HFrEF）和心力衰竭恶化（WHF）患者可能从新型心力衰竭治疗中获益更大。我们通过左心室功能障碍的严重程度研究了 HFrEF 和 WHF 患者的特征和结局。
我们在 2009 年 1 月至 2018 年 12 月期间，在杜克大学识别出患有慢性有症状的 HFrEF（左心室射血分数[LVEF]≤35%）和 WHF 证据（在指数超声心动图后 12 个月内急诊就诊或因急性 HF 住院）的患者。患者按 LVEF≤25%或 26%至 35%进行分层。Cox 模型用于估计整个 LVEF 范围内的特定原因风险比和 5 年死亡和住院事件发生率。
在 2823 例 HFrEF 和 WHF 患者中，1620 例（57.4%）LVEF≤25%，1203 例（42.6%）LVEF 26%至 35%。与 LVEF 26%至 35%的患者相比，LVEF≤25%的患者更年轻，更常见为男性，心血管合并症负担较低。LVEF≤25%的患者接受β受体阻滞剂治疗的比例较低（85.9%比 90.5%），但接受盐皮质激素受体拮抗剂治疗的比例较高（49.3%比 41.1%）和植入式除颤器（41.3%比 28.2%）。LVEF≤25%的患者死亡风险（HR 1.24[95%CI 1.11-1.38]）、全因住院风险（HR 1.21[95%CI 1.10-1.33]）和 HF 住院风险（HR 1.25[95%CI 1.10-1.38]）显著更高，直至 5 年。
超过一半的慢性 HFrEF 和 WHF 患者存在严重的左心室功能障碍。LVEF≤25%的患者与 LVEF 26%至 35%的患者在合并症、HF 治疗和结局方面存在显著差异。
