Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, 783-8505, Japan.
Department of Cardiology, Chikamori Hospital, Kochi, Japan.
ESC Heart Fail. 2022 Jun;9(3):1853-1863. doi: 10.1002/ehf2.13885. Epub 2022 Mar 30.
AIMS: The aim of this study was to elucidate the clinical characteristics, including frailty status, of patients with heart failure with preserved ejection fraction (HFpEF) in comparison with those in patients with heart failure with reduced ejection fraction (HFrEF) in a super-aged region of Japan. METHODS AND RESULTS: Of the 1061 Japanese patients enrolled in the Kochi YOSACOI study, a multicentre registry, we divided 645 patients (median age of 81 years [interquartile range, 72-87 years]; women, 49.1%) into two groups, HFpEF patients (61.2%) and HFrEF patients (38.8%). Physical frailty was diagnosed on the basis of the Japanese version of Cardiovascular Health (J-CHS) Study criteria. Patients for whom left ventricular ejection fraction data were not available (n = 19), patients with heart failure with mildly reduced ejection fraction (n = 172), and patients who were not assessed by the J-CHS criteria (n = 225) were excluded. The median ages of the HFpEF and HFrEF patients were 84 and 76 years, respectively. The proportion of patients with HFpEF gradually increased with advance of age. The proportion of patients with three or more comorbidities was larger in HFpEF patients than in HFrEF patients (77.9% vs. 65.6%, P = 0.003). Handgrip strength was significantly lower in HFpEF patients than in HFrEF patients for both men (P < 0.001) and women (P = 0.041). Comfortable 5 m walking speed was significantly slower in HFpEF patients than in HFrEF patients (P < 0.001). The proportions of patients with physical frailty were 55.2% in HFpEF patients and 46.8% in HFrEF patients, and the proportion was significantly higher in HFpEF patients (P = 0.043). In multivariate analysis, physical frailty was associated with advanced age [odds ratio (OR), 1.030; 95% confidence interval (CI), 1.010-1.050; P = 0.023] and low albumin level (OR, 0.334; 95% CI, 0.192-0.582; P < 0.001) in HFpEF patients, and physical frailty was associated with women (OR, 2.150; 95% CI, 1.030-4.500; P = 0.042) and anaemia (OR, 2.840; 95% CI, 1.300-6.230; P = 0.003) in HFrEF patients. CONCLUSIONS: In a super-aged population of HF patients in Japan, HFpEF patients are more likely to be frail/have a high frailty status compared with HFrEF patients. The results suggested that physical frailty is associated with extracardiac factors in both HFpEF patients and HFrEF patients.
目的：本研究旨在阐明心力衰竭射血分数保留型（HFpEF）患者与射血分数降低型心力衰竭（HFrEF）患者的临床特征，包括虚弱状态，在日本的一个超老龄地区。
方法和结果：在 Kochi YOSACOI 研究的 1061 名日本患者中，我们将 645 名患者（中位年龄 81 岁[四分位距 72-87 岁]；女性占 49.1%）分为两组，HFpEF 患者（61.2%）和 HFrEF 患者（38.8%）。根据日本心血管健康研究（J-CHS）标准诊断身体虚弱。排除了左心室射血分数数据不可用的患者（n=19）、射血分数轻度降低的心力衰竭患者（n=172）和未按 J-CHS 标准评估的患者（n=225）。HFpEF 和 HFrEF 患者的中位年龄分别为 84 岁和 76 岁。HFpEF 患者的比例随年龄的增长而逐渐增加。HFpEF 患者合并三种或三种以上合并症的比例高于 HFrEF 患者（77.9% vs. 65.6%，P=0.003）。男性（P<0.001）和女性（P=0.041）HFpEF 患者的握力均明显低于 HFrEF 患者。HFpEF 患者舒适的 5 米步行速度明显慢于 HFrEF 患者（P<0.001）。HFpEF 患者身体虚弱的比例为 55.2%，HFrEF 患者为 46.8%，HFpEF 患者明显更高（P=0.043）。多因素分析显示，HFpEF 患者中，身体虚弱与高龄（比值比[OR]，1.030；95%置信区间[CI]，1.010-1.050；P=0.023）和低白蛋白水平（OR，0.334；95%CI，0.192-0.582；P<0.001）相关，HFrEF 患者中，身体虚弱与女性（OR，2.150；95%CI，1.030-4.500；P=0.042）和贫血（OR，2.840；95%CI，1.300-6.230；P=0.003）相关。
结论：在日本超老龄心力衰竭患者人群中，HFpEF 患者比 HFrEF 患者更容易出现虚弱/高虚弱状态。结果表明，身体虚弱与 HFpEF 患者和 HFrEF 患者的心脏外因素有关。
Eur J Prev Cardiol. 2021-8-9
Zhonghua Xin Xue Guan Bing Za Zhi. 2021-4-24
J Gen Fam Med. 2025-7-28
Heart Fail Rev. 2024-9
J Cachexia Sarcopenia Muscle. 2024-2
N Engl J Med. 2021-10-14
N Engl J Med. 2021-7-15
Eur J Prev Cardiol. 2021-8-9
Circ Heart Fail. 2020-10
J Am Coll Cardiol. 2019-8-6
Eur J Heart Fail. 2018-9-18
Curr Heart Fail Rep. 2018-2
Zotero 插件
