Soufi Mohamad K, Almahmoud Mohamed F, Kadri Amer N, Dang Alexander, Jain Rishabh R, McFarland Joseph R, Pinsky Simon, Rana Milin N, Ogbonna Precious, Khalife Wissam I
Division of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, TX.
Department of Cardiovascular Medicine, Beaumont Health/Dearborn Hospital, Dearborn, MI.
Curr Probl Cardiol. 2023 May;48(5):101631. doi: 10.1016/j.cpcardiol.2023.101631. Epub 2023 Feb 3.
Heart failure with mildly-reduced ejection fraction (HFmrEF) of 40%-49% is an under-recognized type of heart failure. The prognosis and predictors of outcomes of stable mildly-reduced ejection fraction (EF) of 1 year are unclear. This is a retrospective study. Included patients had stable left ventricular ejection fraction (LVEF) for at least 1 year (n = 609) and were classified into 3 groups based on LVEF. Clinical outcome measures were all-cause mortality, cardiac mortality, and HF hospitalization (HFH). In patients with stable HFmrEF of one year, the predictors of clinical outcomes and hospital length of stay (LOS) were studied. Patients with stable HFmrEF had lower HFH rate compared to stable HFrEF with HR = 0.52 (95% CI = 0.39-0.70), P = 0.0001, and a higher HFH rate compared to stable HFpEF with HR = 1.23 (95% CI = 1.01-1.50), P = 0.032. Mortality rates were similar between all groups. In the stable HFmrEF patients, beta-blockers caused lower cardiac mortality, and CKD had fewer HFH. Unfavorable predictors were loop diuretics for mortality, and higher NYHA class for HFH. Smoking and CKD were associated with a longer hospital stay. Stable HFmrEF patients with at least one HF admission had higher mortality. Patients with stable HFmrEF had a lower HFH rate compared to stable HFrEF and higher HFH rate compared to stable HFpEF. In patients with stable HFmrEF, CKD, NYHA class, beta-blockers, and loop diuretics were predictors of clinical outcomes. Smoking and CKD were predictors of hospital LOS.
射血分数轻度降低（HFmrEF）为40%-49%的心力衰竭是一种未得到充分认识的心力衰竭类型。1年稳定的轻度降低射血分数（EF）的预后及结局预测因素尚不清楚。这是一项回顾性研究。纳入的患者左心室射血分数（LVEF）稳定至少1年（n = 609），并根据LVEF分为3组。临床结局指标为全因死亡率、心脏死亡率和心力衰竭住院（HFH）。对1年稳定HFmrEF患者的临床结局及住院时间（LOS）的预测因素进行了研究。与稳定的射血分数降低的心力衰竭（HFrEF）患者相比，稳定HFmrEF患者的HFH率较低，风险比（HR）=0.52（95%置信区间[CI]=0.39-0.70），P = 0.0001；与稳定的射血分数保留的心力衰竭（HFpEF）患者相比，HFH率较高，HR = 1.23（95%CI = 1.01-1.50），P = 0.032。所有组之间的死亡率相似。在稳定的HFmrEF患者中，β受体阻滞剂可降低心脏死亡率，而慢性肾脏病（CKD）患者的HFH次数较少。不良预测因素为袢利尿剂与死亡率相关，纽约心脏协会（NYHA）分级较高与HFH相关。吸烟和CKD与住院时间延长有关。至少有1次心力衰竭住院的稳定HFmrEF患者死亡率较高。与稳定的HFrEF患者相比稳定HFmrEF患者的HFH率较低，与稳定的HFpEF患者相比HFH率较高。在稳定HFmrEF患者中，CKD、NYHA分级、β受体阻滞剂和袢利尿剂是临床结局的预测因素。吸烟和CKD是住院LOS的预测因素。
