射血分数保留的心力衰竭中负荷整合舒张指数的时间敏感性预后性能：一项前瞻性多中心观察研究。

Time-sensitive prognostic performance of an afterload-integrated diastolic index in heart failure with preserved ejection fraction: a prospective multicentre observational study.

机构信息

Department of Cardiovascular Medicine, Yao Municipal Hospital, Yao, Japan

Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan.

出版信息

BMJ Open. 2022 Aug 10;12(8):e059614. doi: 10.1136/bmjopen-2021-059614.

DOI:10.1136/bmjopen-2021-059614

PMID:35948381

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9379494/

Abstract

OBJECTIVES

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.

SETTING

A prospective, multicentre observational registry of collaborating hospitals in Osaka, Japan.

PARTICIPANTS

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.

PRIMARY OUTCOME MEASURES

All-cause mortality and/or re-admission for heart failure were evaluated after discharge.

RESULTS

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.

CONCLUSIONS

Time-sensitive prognostic performance of Ed/Ea, an afterload-integrated diastolic index, was observed in older patients with HFpEF.

TRIAL REGISTRATION NUMBER

UMIN000021831.

摘要

目的

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。

设置

日本大阪合作医院的前瞻性、多中心观察性登记处。

参与者

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。

主要观察指标

评估出院后全因死亡率和/或心力衰竭再入院。

结果

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。