Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, PR China; NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, 510080, PR China; National - Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, 510080, PR China.
Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, PR China; NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University), Guangzhou, 510080, PR China; National - Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, 510080, PR China.
Atherosclerosis. 2022 Mar;344:1-6. doi: 10.1016/j.atherosclerosis.2022.01.013. Epub 2022 Jan 21.
Heart failure with preserved ejection fraction (HFpEF) patients have a high burden of comorbidities that could predispose them to ischemic vascular event. The profile of ischemic risk among HFpEF patients is not fully understood. We aim to evaluate the risk, risk factors, and prognostic significance of ischemic events among HFpEF patients.
A total of 1767 HFpEF patients from Americas in the TOPCAT trial were included in our analysis. Ischemic event was defined as myocardial infarction or ischemic stroke during follow-up. Multivariate competing risks regression model was used to identify risk factors of ischemic event. Time-dependent Cox models were constructed to evaluate the association of incident ischemic event and mortality risk.
During a median follow-up period of 2.9 years, 164 (9.3%) patients had at least 1 ischemic event. The crude incidence rate was 3.3% per year. Body mass index, prior myocardial infarction, insulin use, peripheral artery disease, hypertension, and current smoking were independent risk factors of ischemic event in HFpEF patients. HF hospitalization turned out to be an important trigger of ischemic event. Risk of ischemic event increased 4.7-fold (hazard ratio 4.70, 95% confidence interval: 2.23-9.89, p < 0.001) within the first month after the first HF hospitalization, and dropped rapidly thereafter. Incident ischemic event was associated with significant higher short-term risks of all-cause mortality and cardiovascular mortality.
HFpEF patients from Americas were at a high risk of ischemic events, which was associated with mortality risk. A subset of baseline characteristics and HF hospitalization during follow-up could predict ischemic event.
射血分数保留的心力衰竭（HFpEF）患者合并症负担较高，这可能使他们易发生缺血性血管事件。HFpEF 患者的缺血风险特征尚未完全明确。本研究旨在评估 HFpEF 患者发生缺血事件的风险、相关危险因素和预后意义。
共纳入 1767 例来自美洲的 TOPCAT 试验中的 HFpEF 患者进行分析。缺血事件定义为随访期间发生心肌梗死或缺血性卒中。采用多变量竞争风险回归模型确定缺血事件的危险因素。构建时间依赖性 Cox 模型评估新发缺血事件与死亡率风险的相关性。
中位随访 2.9 年期间，164 例（9.3%）患者至少发生了 1 次缺血事件。粗发生率为每年 3.3%。体质指数、既往心肌梗死、胰岛素使用、外周动脉疾病、高血压和当前吸烟是 HFpEF 患者发生缺血事件的独立危险因素。HF 住院是缺血事件的重要触发因素。HF 首次住院后第 1 个月内，缺血事件风险增加 4.7 倍（风险比 4.70，95%置信区间：2.23-9.89，p<0.001），此后迅速下降。发生缺血事件与全因死亡率和心血管死亡率的短期风险显著增加相关。
来自美洲的 HFpEF 患者发生缺血事件的风险较高，且与死亡率风险相关。部分基线特征和随访期间的 HF 住院可预测缺血事件。
