Department of Cardiovascular Medicine, Tokushima University Hospital, 2-50-1 Kuramoto, Tokushima, Japan.
Department of Community Medicine for Cardiology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan.
ESC Heart Fail. 2022 Dec;9(6):4020-4029. doi: 10.1002/ehf2.14127. Epub 2022 Aug 26.
Abnormal left ventricular diastolic response to preload stress can be an early marker of heart failure (HF). The aim of this study was to assess clinical course in patients with HF with preserved ejection fraction (HFpEF) who underwent preload stress echocardiography. In the subgroup analysis, we assessed the prognosis of patients with unstable signs during preload stress classified by treatment strategies.
We prospectively conducted preload stress echocardiographic studies between January 2006 and December 2013 in 211 patients with HFpEF. Fifty-eight patients had abnormal diastolic reserve during preload stress (unstable impaired relaxation: unstable IR). Of 58 patients with unstable IR, 19 patients were assigned to additional therapy by increased or additional therapy and 39 patients were assigned to standard therapy. Composite outcomes were prespecified as the primary endpoint of death and hospitalization for deteriorating HF. During a median period of 6.9 years, 19 patients (33%) reached the composite outcome. Unstable group with standard therapy had significantly shorter event-free survival than stable group. Patients with uptitration of therapy had longer event-free survival than those with standard therapy group after adjustment of laboratory data (hazard ratio, 0.20, 95% confidence interval, 0.05-0.90; P = 0.036); the 10 year event-free survival in patients with and without uptitration of therapy was 93% and 51%, respectively (P = 0.023).
Patients with unstable sign had significantly shorter event-free survival than patients with stable sign. After additional therapy, the prognosis of patients with unstable signs improved. This technique may impact decision-making for improving their prognosis.
左心室对前负荷压力的异常舒张反应可能是心力衰竭（HF）的早期标志物。本研究旨在评估接受前负荷压力超声心动图检查的射血分数保留的心力衰竭（HFpEF）患者的临床病程。在亚组分析中，我们根据治疗策略评估了前负荷压力时不稳定征象患者的预后。
我们前瞻性地进行了 2006 年 1 月至 2013 年 12 月期间 211 例 HFpEF 患者的前负荷压力超声心动图研究。58 例患者在前负荷压力下舒张储备异常（不稳定的松弛受损：不稳定 IR）。在 58 例不稳定 IR 患者中，19 例患者接受了增加或额外治疗的额外治疗，39 例患者接受了标准治疗。复合结局是死亡和因恶化的 HF 住院的主要终点。在中位数为 6.9 年的随访期间，19 例患者（33%）达到了复合结局。与稳定组相比，标准治疗的不稳定组无事件生存率显著降低。在调整实验室数据后，接受滴定治疗的患者的无事件生存率长于标准治疗组（危险比，0.20，95%置信区间，0.05-0.90；P=0.036）；接受和未接受滴定治疗的患者的 10 年无事件生存率分别为 93%和 51%（P=0.023）。
不稳定征象患者的无事件生存率明显短于稳定征象患者。在接受额外治疗后，不稳定征象患者的预后得到改善。这项技术可能会影响改善预后的决策。
