射血分数保留、轻度降低与降低的心衰患者的全面特征分析——来自 ESC-HFA EORP 心衰长期注册登记研究的结果
A comprehensive characterization of acute heart failure with preserved versus mildly reduced versus reduced ejection fraction - insights from the ESC-HFA EORP Heart Failure Long-Term Registry.
机构信息
1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.
Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
出版信息
Eur J Heart Fail. 2022 Feb;24(2):335-350. doi: 10.1002/ejhf.2408. Epub 2022 Jan 10.
AIMS
To perform a comprehensive characterization of acute heart failure (AHF) with preserved (HFpEF), versus mildly reduced (HFmrEF) versus reduced ejection fraction (HFrEF).
METHODS AND RESULTS
Of 5951 participants in the ESC HF Long-Term Registry hospitalized for AHF (acute coronary syndromes excluded), 29% had HFpEF, 18% HFmrEF, and 53% HFrEF. Hospitalization reasons were most commonly atrial fibrillation (more in HFmrEF and HFpEF), followed by ischaemia (HFmrEF), infection (HFmrEF and HFpEF), worsening renal function (HFrEF), and uncontrolled hypertension (HFmrEF and HFpEF). Hospitalization characteristics included lower blood pressure, more oedema and higher natriuretic peptides with lower ejection fraction, similar pulmonary congestion, more mitral regurgitation in HFrEF and HFmrEF and more tricuspid regurgitation in HFrEF. In-hospital mortality was 3.4% in HFrEF, 2.1% in HFmrEF and 2.2% in HFpEF. Intravenous diuretic (∼80%) and nitrate (∼15%) use was similar but inotrope use greater in HFrEF (16%, vs. HFmrEF 7.4% vs. HFpEF 5.3%). Weight loss and estimated glomerular filtration rate improvement were greater in HFrEF, whereas reduction in natriuretic peptides was similar. Over 1 year post-discharge, events per 100 patient-years (95% confidence interval) in HFrEF versus HFmrEF versus HFpEF were: all-cause death 22 (20-24) versus 17 (14-20) versus 17 (15-20); cardiovascular (CV) death 12 (10-13) versus 8.6 (6.6-11) versus 8.4 (6.9-10); non-CV death 2.4 (1.8-3.1) versus 3.3 (2.1-4.8) versus 4.5 (3.5-5.9); all-cause hospitalization 48 (45-51) versus 35 (31-40) versus 42 (39-46); HF hospitalization 29 (27-32) versus 19 (16-22) versus 17 (15-20); and non-CV hospitalization 7.7 (6.6-8.9) versus 9.6 (7.5-12) versus 15 (13-17).
CONCLUSION
In AHF, HFrEF is more severe and has greater in-hospital mortality. Post-discharge, HFrEF has greater CV risk, HFpEF greater non-CV risk, and HFmrEF lower overall risk.
目的
对射血分数保留型心力衰竭（HFpEF）、射血分数轻度降低型心力衰竭（HFmrEF）和射血分数降低型心力衰竭（HFrEF）进行全面特征描述。
方法和结果
在 ESC HF 长期注册研究中，5951 名因急性心力衰竭（排除急性冠状动脉综合征）住院的患者中，29%为 HFpEF，18%为 HFmrEF，53%为 HFrEF。住院的主要原因是心房颤动（HFmrEF 和 HFpEF 中更常见），其次是缺血（HFmrEF）、感染（HFmrEF 和 HFpEF）、肾功能恶化（HFrEF）和未控制的高血压（HFmrEF 和 HFpEF）。住院特征包括更低的血压、更多的水肿和更低的射血分数时更高的利钠肽、相似的肺淤血、HFmrEF 和 HFrEF 中更多的二尖瓣反流和 HFrEF 中更多的三尖瓣反流。HFrEF 的院内死亡率为 3.4%，HFmrEF 为 2.1%，HFpEF 为 2.2%。静脉利尿剂（约 80%）和硝酸盐（约 15%）的使用相似，但 HFrEF 中使用正性肌力药的比例更高（16%，HFmrEF 为 7.4%，HFpEF 为 5.3%）。HFrEF 的体重减轻和估计肾小球滤过率改善更大，而利钠肽的降低相似。出院后 1 年，HFrEF 与 HFmrEF 与 HFpEF 每 100 例患者年的事件发生率（95%置信区间）分别为：全因死亡 22（20-24）比 17（14-20）比 17（15-20）；心血管死亡 12（10-13）比 8.6（6.6-11）比 8.4（6.9-10）；非心血管死亡 2.4（1.8-3.1）比 3.3（2.1-4.8）比 4.5（3.5-5.9）；全因住院 48（45-51）比 35（31-40）比 42（39-46）；心力衰竭住院 29（27-32）比 19（16-22）比 17（15-20）；非心血管住院 7.7（6.6-8.9）比 9.6（7.5-12）比 15（13-17）。
结论
在急性心力衰竭中，HFrEF 更严重，院内死亡率更高。出院后，HFrEF 的心血管风险更大，HFpEF 的非心血管风险更大，HFmrEF 的总体风险更低。
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