Department of Cardiovascular Medicine, Yao Municipal Hospital, Yao, Japan
Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan.
BMJ Open. 2022 Aug 10;12(8):e059614. doi: 10.1136/bmjopen-2021-059614.
The prognostic significance of an afterload-integrated diastolic index, the ratio of diastolic elastance (Ed) to arterial elastance (Ea) (Ed/Ea=[E/e']/[0.9×systolic blood pressure]), is valid for 1 year after discharge in older patients with heart failure with preserved ejection fraction (HFpEF). We aimed to clarify the association with changes in Ed/Ea from enrolment to 1 year and prognosis thereafter in patients with HFpEF.
A prospective, multicentre observational registry of collaborating hospitals in Osaka, Japan.
We enrolled 659 patients with HFpEF hospitalised for acute decompensated heart failure (men/women: 296/363). Blood tests and transthoracic echocardiography were performed before discharge and at 1 year after.
All-cause mortality and/or re-admission for heart failure were evaluated after discharge.
High Ed/Ea assessed before discharge was a significant prognostic factor during the first, but not the second, year after discharge in all-cause mortality or all-cause mortality and/or re-admission for heart failure. When re-analysis was performed using the value of Ed/Ea at 1 year after discharge, high Ed/Ea was significant for the prognosis during the second year for both end points (p=0.012 and p=0.033, respectively). The poorest mortality during 1‒2 years after enrolment was observed in those who showed a worsening Ed/Ea during the first year associated with larger left ventricular mass index and reduced left ventricular ejection fraction. In all-cause mortality and/or re-admission for heart failure, the event rate during 1‒2 years was highest in those with persistently high Ed/Ea even after 1 year.
Time-sensitive prognostic performance of Ed/Ea, an afterload-integrated diastolic index, was observed in older patients with HFpEF.
UMIN000021831.
在射血分数保留的心力衰竭（HFpEF）老年患者出院后 1 年内，舒张后负荷综合指数，即舒张弹性（Ed）与动脉弹性（Ea）之比（Ed/Ea=[E/e']/[0.9×收缩压]）的预后意义是有效的。我们旨在明确 Ed/Ea 从入组到 1 年的变化与 HFpEF 患者预后的关系。
日本大阪合作医院的前瞻性、多中心观察性登记处。
我们纳入了 659 名因急性失代偿性心力衰竭住院的 HFpEF 患者（男性/女性：296/363）。在出院前和 1 年后进行血液检查和经胸超声心动图检查。
评估出院后全因死亡率和/或心力衰竭再入院。
出院后第一年，高 Ed/Ea 是全因死亡率或全因死亡率和/或心力衰竭再入院的显著预后因素，但第二年并非如此。当使用出院后 1 年的 Ed/Ea 值进行重新分析时，高 Ed/Ea 对两个终点的第二年预后均有意义（p=0.012 和 p=0.033）。在入组后 1‒2 年期间，死亡率最高的是那些在第一年期间 Ed/Ea 恶化的患者，这与左心室质量指数增加和左心室射血分数降低有关。在全因死亡率和/或心力衰竭再入院方面，即使在 1 年后 Ed/Ea 持续升高，全因死亡率和/或心力衰竭再入院的发生率在 1‒2 年内最高。
在 HFpEF 老年患者中，观察到 Ed/Ea（一种后负荷综合舒张指数）的时间敏感预后性能。
UMIN000021831。
