Shikama Taku, Otaki Yoichiro, Watanabe Tetsu, Takahashi Hiroki, Kurokawa Tasuku, Tamura Harutoshi, Kato Shigehiko, Nishiyama Satoshi, Arimoto Takanori, Watanabe Masafumi
Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine Yamagata Japan.
Circ Rep. 2022 Jul 15;4(8):378-387. doi: 10.1253/circrep.CR-22-0063. eCollection 2022 Aug 10.
Lower extremity artery disease (LEAD) is an arterial occlusive disease characterized by an insufficient blood supply to the lower limb arteries. The HFPEF score, comprising Heavy, Hypertensive, atrial Fibrillation, Pulmonary hypertension, Elder, and Filling pressure, has been developed to identify patients at high risk of heart failure (HF) with preserved ejection fraction. This study assessed the impact of modified HFPEF scores on chronic limb-threatening ischemia (CLTI) in patients with LEAD. This study was a prospective observational study. Because the definition of obesity differs by race, we calculated the modified HFPEF score using a body mass index >25 kg/m to define obesity in 293 patients with LEAD who underwent first endovascular therapy. The primary endpoints were newly developed and recurrent CLTI. The secondary endpoint was a composite of events, including mortality and rehospitalization due to worsening HF and/or CLTI. The modified HFPEF score increased significantly with advancing Fontaine classes. Multivariate Cox proportional hazard analysis revealed that the modified HFPEF score was an independent predictor of newly developed and recurrent CLTI and composite events. The net reclassification index and integrated discrimination improvement were significantly improved by adding the modified HFPEF score to the basic predictors. The modified HFPEF score was associated with LEAD severity and future CLTI development, suggesting that it could be a feasible marker for patients with LEAD.
下肢动脉疾病（LEAD）是一种动脉闭塞性疾病，其特征是下肢动脉血液供应不足。HFPEF评分由肥胖（Heavy）、高血压（Hypertensive）、心房颤动（atrial Fibrillation）、肺动脉高压（Pulmonary hypertension）、老年（Elder）和充盈压（Filling pressure）组成，已被开发用于识别射血分数保留的心力衰竭（HF）高危患者。本研究评估了改良的HFPEF评分对LEAD患者慢性肢体威胁性缺血（CLTI）的影响。 本研究是一项前瞻性观察性研究。由于肥胖的定义因种族而异，我们使用体重指数>25 kg/m²来定义肥胖，计算了293例接受首次血管内治疗的LEAD患者的改良HFPEF评分。主要终点是新发生的和复发性CLTI。次要终点是包括因HF和/或CLTI恶化导致的死亡率和再次住院在内的事件复合终点。改良的HFPEF评分随着Fontaine分级的进展而显著增加。多变量Cox比例风险分析显示，改良的HFPEF评分是新发生的和复发性CLTI以及复合事件的独立预测因素。通过将改良的HFPEF评分添加到基本预测因素中，净重新分类指数和综合判别改善显著提高。改良的HFPEF评分与LEAD严重程度和未来CLTI的发生相关，表明它可能是LEAD患者的一个可行标志物。
