Shirotani Shota, Jujo Kentaro, Takada Takuma, Abe Takuro, Kishihara Makoto, Watanabe Shonosuke, Endo Nana, Fujita Hiroko, Murasaki Satoshi, Yamaguchi Junichi
Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan; Department of Cardiology, Tokyo Metropolitan Health and Medical Treatment Corporation Tama-Hokubu Medical Center, Tokyo, Japan.
Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan.
Int J Cardiol. 2023 Feb 15;373:83-89. doi: 10.1016/j.ijcard.2022.11.049. Epub 2022 Nov 28.
Few interventions have shown improved prognosis in patients with heart failure and preserved ejection fraction (HFpEF). Serum chloride levels, which are affected by serum renin secretion, are associated with the prognosis of HFpEF patients. However, the relationship between serum chloride levels and the effects of renin-angiotensin system inhibitors (RASi) in HFpEF patients remains unclear. We investigated whether the prognostic benefit of RASi depends on baseline serum chloride levels in HFpEF patients.
This observational study included 506 hospitalized patients with HFpEF (ejection fraction ≥50%) who were discharged. They were divided into two categories based on serum chloride levels at admission (cutoff level: 101 mEq/L) according to previous reports. In each chloride category, all-cause mortality, the primary endpoint, was compared between patients who received RASi and those who did not.
Patients who received RASi had a significantly lower mortality rate after discharge than those who did not, but only in the lower chloride category (log-rank, P = 0.001). Multivariable Cox regression analysis confirmed the effect of risk reduction by RASi on all-cause mortality in the lower chloride category (adjusted hazard ratio: 0.31, 95% confidence interval: 0.11-0.84). The prognostic advantages of RASi were evident in the lower chloride category, but not in the higher chloride category, at admission (P for interaction = 0.027).
RASi administration was associated with an improved prognosis only in HFpEF patients with a low baseline serum chloride level. Clinicians should consider RASi administration if patients' serum chloride levels are low, to improve the long-term prognosis of HFpEF patients.
很少有干预措施能改善射血分数保留的心力衰竭（HFpEF）患者的预后。受血清肾素分泌影响的血清氯水平与HFpEF患者的预后相关。然而，血清氯水平与HFpEF患者中肾素-血管紧张素系统抑制剂（RASi）的疗效之间的关系仍不清楚。我们研究了RASi对HFpEF患者的预后益处是否取决于基线血清氯水平。
这项观察性研究纳入了506例出院的住院HFpEF患者（射血分数≥50%）。根据既往报道，按照入院时的血清氯水平（临界值：101 mEq/L）将他们分为两类。在每个氯水平类别中，比较接受RASi治疗的患者和未接受RASi治疗的患者的全因死亡率（主要终点）。
接受RASi治疗的患者出院后的死亡率显著低于未接受治疗的患者，但仅在氯水平较低的类别中如此（对数秩检验，P = 0.001）。多变量Cox回归分析证实了RASi对氯水平较低类别中全因死亡率的降低作用（调整后的风险比：0.31，95%置信区间：0.11 - 0.84）。入院时，RASi的预后优势在氯水平较低的类别中明显，但在氯水平较高的类别中不明显（交互作用P = 0.027）。
仅在基线血清氯水平较低的HFpEF患者中，使用RASi与预后改善相关。如果患者血清氯水平较低，临床医生应考虑使用RASi，以改善HFpEF患者的长期预后。
