Department of Medicine, Karolinska Institute, Stockholm, Sweden.
Department of Cardiology, Karolinska University Hospital, Stockholm, S-17176, Sweden.
ESC Heart Fail. 2022 Aug;9(4):2125-2138. doi: 10.1002/ehf2.13922. Epub 2022 Apr 10.
We present the baseline characteristics of the PREFERS Stockholm epidemiological study on the natural history and course of new onset heart failure (HF) aiming to improve phenotyping focusing on HF with preserved left ventricular ejection fraction (HFpEF) pathophysiology.
New onset HF patients diagnosed in hospital or at outpatient HF clinics were included at five Stockholm hospitals 2015-2018 and characterized by N-terminal pro brain natriuretic peptide (NT-proBNP), biomarkers, echocardiography, and cardiac magnetic resonance imaging (subset). HFpEF [left ventricular ejection fraction (LVEF) ≥ 50%] was compared with HF with mildly reduced LVEF (HFmrEF; LVEF 41-49%) and with HF with reduced LVEF (HFrEF; LVEF ≤ 40%). We included 547 patients whereof HFpEF (n = 137; 25%), HFmrEF (n = 61; 11%), and HFrEF (n = 349; 64%). HFpEF patients were older (76; 70-81 years; median; interquartile range) than HFrEF (67; 58-74; P < 0.001), more often women (49% vs. 30%; P < 0.001), and had significantly higher comorbidity burden. They more often had atrial fibrillation, hypertension, and renal dysfunction. NT-proBNP was lower in HFpEF (896; 462-1645 ng/L) than in HFrEF (1160; 563-2370; P = 0.005). In HFpEF, left ventricular (LV) diameters and volumes were smaller (P < 0.001) and septal and posterior wall thickness and relative wall thickness higher (P < 0.001). E/é ≥ 14 was present in 26% of HFpEF vs. 32% of HFrEF (P = 0.017) and left atrial volume index > 34 mL/m in 57% vs. 61% (P = 0.040). HFmrEF patients were intermediary between HFpEF and HFrEF for LV mass, LV volumes, and RV volumes but had the highest proportion of left ventricular hypertrophy and the lowest proportion of elevated E/é.
Phenotype data in new onset HF patients recruited in a broad clinical setting showed that 25% had HFpEF, were older, more often women, and had greater comorbidity burden. PREFERS is well suited to further explore biomarker and imaging components of HFpEF pathophysiology and may contribute to the emerging knowledge of HF epidemiology.
Clinicaltrials.gov identifier: NCT03671122.
我们介绍了 PREFERS 斯德哥尔摩流行病学研究的基线特征，该研究旨在改善新诊断心力衰竭（HF）的表型，重点关注左心室射血分数保留的 HF（HFpEF）的病理生理学。
2015 年至 2018 年，在斯德哥尔摩的五家医院，纳入了在医院或门诊 HF 诊所诊断为新发 HF 的患者，并通过 N 端脑利钠肽前体（NT-proBNP）、生物标志物、超声心动图和心脏磁共振成像（亚组）进行特征描述。HFpEF [左心室射血分数（LVEF）≥50%]与 HF 伴轻度降低的 LVEF（HFmrEF；LVEF 41-49%）和 HF 伴降低的 LVEF（HFrEF；LVEF≤40%）进行比较。我们共纳入了 547 名患者，其中 HFpEF（n=137；25%）、HFmrEF（n=61；11%）和 HFrEF（n=349；64%）。HFpEF 患者比 HFrEF 患者年龄更大（76[70-81 岁]；中位数；四分位距），女性更多（49%比 30%；P<0.001），且合并症负担显著更高。他们更常患有心房颤动、高血压和肾功能障碍。HFpEF 患者的 NT-proBNP 水平低于 HFrEF（896[462-1645ng/L]比 1160[563-2370ng/L]；P=0.005）。HFpEF 患者的左心室（LV）直径和容量更小（P<0.001），室间隔和后壁厚度以及相对壁厚度更高（P<0.001）。HFpEF 中有 26%的患者 E/é≥14，而 HFrEF 中有 32%（P=0.017），HFpEF 中有 57%的患者左心房容积指数>34ml/m，而 HFrEF 中有 61%（P=0.040）。HFmrEF 患者在 LV 质量、LV 容量和 RV 容量方面处于 HFpEF 和 HFrEF 之间，但 LV 肥厚的比例最高，E/é 升高的比例最低。
在广泛的临床环境中招募的新发 HF 患者的表型数据表明，25%的患者为 HFpEF，年龄更大，女性更多，合并症负担更重。PREFERS 非常适合进一步探索 HFpEF 病理生理学的生物标志物和影像学成分，并可能有助于新兴的 HF 流行病学知识的发展。
Clinicaltrials.gov 标识符：NCT03671122。
