Department of Medicine, Sarasota Memorial Health Care System, Florida State University College of Medicine, Sarasota, FL, USA.
Department of Medicine, Division of Cardiology, Orlando Health, Orlando, FL, USA.
ESC Heart Fail. 2022 Aug;9(4):2538-2547. doi: 10.1002/ehf2.13965. Epub 2022 May 15.
Temporal conversions among ejection fraction (EF) classes can occur across the heart failure (HF) spectrum reflecting amended structural and functional outcomes unaccounted for by current taxonomy. This retrospective study aims to investigate the differences in serum laboratory values, guideline-directed medical therapy (GDMT), and co-morbidity burden across EF conversion groups.
Heart failure patients at least 18-year-old who obtained at least two echocardiograms between January 2018 and January 2020 were identified using ICD-10 codes. Analysis of variance, chi-square tests, and analysis of means for proportions were used as appropriate to identify associations with class conversion groups. A total of 874 patients who underwent 1748 echocardiograms on unique visits were categorized according to initial EF as HF with preserved EF (HFpEF) (n = 531, 61%), HF with mildly reduced or midrange EF (HFmrEF) (n = 132, 15%), or HF with reduced EF (HFrEF) (n = 211, 24%). In accordance with follow-up EF, class conversions were categorized into HF with improved EF (HFiEF) (n = 143, 16%), HF with worsened EF (HFwEF) (n = 171, 20%), or HF with stable EF (HFsEF) (n = 560, 64%). The average age was 75 ± 13 years old; 54% were male, 85% were Caucasian, 11% were African American, and 4% other. The mean time between EF assessments was 208.6 ± 170.2 days. Serum sodium levels were greater in HFwEF (139 ± 3 mmol/L) when compared with HFsEF (138 ± 4 mmol/L) (P = 0.05). Pro-BNP levels were higher in HFiEF (12 150 ± 19 554 pg/mL) versus HFsEF (6671 ± 10 525 pg/mL) (P = 0.007). Angiotensin receptor-neprilysin inhibitors (ARNI) were more frequently ordered on index visit in HFiEF (P = 0.03), but no other significant differences in GDMT were identified. Despite similar Elixhauser Co-morbidity Measure (ECM) scores, ECM categorical analysis revealed that HFwEF was more likely to have an established diagnosis of depression (P = 0.03) and a spectrum of psychiatric illnesses (P = 0.03) on preliminary visit. HFsEF was less likely to have an established diagnosis of blood loss anaemia (P = 0.04). Metastatic cancer was more likely to have been diagnosed in HFiEF and less likely in HFsEF (P = 0.002).
Despite similar ECM scores, EF class conversion groups demonstrated salient differences in average serum sodium and pro-BNP levels. Inpatient ARNI orders, psychiatric, hematologic, and oncologic co-morbidity patterns were also significantly different. Findings demonstrate blood-based biomarker patterns and targetable co-morbid conditions which may play a role in future EF class conversion. Dedicated studies evaluating measurements related to GDMT dose-titration, quality of life, and functionality are the next steps in this field of HF.
射血分数（EF）类别之间的时间转换可能发生在心力衰竭（HF）谱中，反映了当前分类法未涵盖的经修正的结构和功能结果。这项回顾性研究旨在调查 EF 转换组之间血清实验室值、指南指导的药物治疗（GDMT）和合并症负担的差异。
使用 ICD-10 代码，通过对至少两次超声心动图的回顾性分析，确定至少 18 岁的心力衰竭患者。使用方差分析、卡方检验和均值分析比例适当地确定与类别转换组的关联。总共对在独特就诊中进行了 1748 次超声心动图检查的 874 名患者进行了分类，根据初始 EF 将其分为射血分数保留的心力衰竭（HFpEF）（n=531，61%）、射血分数轻度降低或中值的心力衰竭（HFmrEF）（n=132，15%）或射血分数降低的心力衰竭（HFrEF）（n=211，24%）。根据随访 EF，类别转换分为射血分数改善的心力衰竭（HFiEF）（n=143，16%）、射血分数恶化的心力衰竭（HFwEF）（n=171，20%）或射血分数稳定的心力衰竭（HFsEF）（n=560，64%）。平均年龄为 75±13 岁；54%为男性，85%为白种人，11%为非裔美国人，4%为其他种族。EF 评估之间的平均时间为 208.6±170.2 天。与 HFsEF（138±4mmol/L）相比，HFwEF（139±3mmol/L）的血清钠水平更高（P=0.05）。与 HFsEF（6671±10525pg/mL）相比，HFiEF（12150±19554pg/mL）的脑钠肽（BNP）水平更高（P=0.007）。指数就诊时更频繁地开具血管紧张素受体-脑啡肽酶抑制剂（ARNI），但在 GDMT 方面没有发现其他显著差异。尽管 Elixhauser 合并症度量（ECM）评分相似，但 ECM 分类分析表明，HFwEF 更有可能在初步就诊时被诊断为抑郁症（P=0.03）和一系列精神疾病（P=0.03）。HFsEF 不太可能被诊断为失血性贫血（P=0.04）。转移性癌症更可能在 HFiEF 中被诊断，而在 HFsEF 中则不太可能（P=0.002）。
尽管 ECM 评分相似，但 EF 类别转换组在平均血清钠和 BNP 水平上表现出明显差异。住院 ARNI 订单、精神病、血液学和肿瘤合并症模式也有显著差异。研究结果表明，血液生物标志物模式和可靶向的合并症可能在未来的 EF 类别转换中发挥作用。评估与 GDMT 剂量滴定、生活质量和功能相关的测量值的专门研究是 HF 领域的下一步。
