Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
Servicio de Cardiología, Complejo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain.
Rev Clin Esp (Barc). 2022 Mar;222(3):152-160. doi: 10.1016/j.rceng.2020.11.005. Epub 2021 May 14.
Patients with heart failure are classified into three phenotypes based on left ventricular ejection fraction. This work aimed to compare the clinical profile, treatment, prognosis, and causes of death of patients with heart failure and reduced (<40%, HF-rEF), preserved (≥50%, HF-pEF), or mid-range (40-49%, HF-mrEF) left ventricular ejection fraction.
An analysis was conducted on the clinical data included in a prospective registry of patients with heart failure who were referred to a specific Cardiology unit from 2010 to 2019.
A total of 1404 patients with HF-rEF, 239 patients with HF-mrEF, and 266 patients with HF-pEF were analyzed. Significant differences were observed among the groups in regard to several clinical characteristics and the frequency of prescription of neurohormonal blocking drugs. A multivariate Cox regression revealed an increased risk of all-cause mortality in patients with HF-pEF (hazard ratio 1.36; 95% confidence interval 1.03-1.80; p = 0.028) and patients with HF-mrEF (hazard ratio 1.36; 95% confidence interval 1.03-1.78; p = 0.029) as compared to patients with HF-rEF. Heart failure was the most frequent cause of death in the three subgroups. A higher relative weight of sudden death as a cause of death was observed among patients with HF-rEF while the relative weight of non-cardiovascular causes of death was higher among patients with HF-pEF and HF-mrEF.
This study confirms the existence of significant differences among patients with HF-rEF, HF-mrEF, and HF-pEF with regard to their clinical profile, therapeutic management, prognosis, and causes of death.
根据左心室射血分数，心力衰竭患者可分为三种表型。本研究旨在比较左心室射血分数降低（<40%，HF-rEF）、保留（≥50%，HF-pEF）或中间范围（40-49%，HF-mrEF）的心力衰竭患者的临床特征、治疗、预后和死亡原因。
对 2010 年至 2019 年期间被转诊至特定心脏病学单位的心力衰竭患者前瞻性登记的临床数据进行了分析。
共分析了 1404 例 HF-rEF 患者、239 例 HF-mrEF 患者和 266 例 HF-pEF 患者。各组在多个临床特征和神经激素阻断药物的处方频率方面存在显著差异。多变量 Cox 回归显示 HF-pEF（危险比 1.36；95%置信区间 1.03-1.80；p=0.028）和 HF-mrEF（危险比 1.36；95%置信区间 1.03-1.78；p=0.029）患者的全因死亡率风险增加。心力衰竭是三个亚组中最常见的死亡原因。HF-rEF 患者死亡的相对突发性更高，而 HF-pEF 和 HF-mrEF 患者非心血管原因死亡的相对权重更高。
本研究证实 HF-rEF、HF-mrEF 和 HF-pEF 患者在临床特征、治疗管理、预后和死亡原因方面存在显著差异。
