急性心力衰竭伴轻度射血分数降低和心肌梗死：一项多机构队列研究。
Acute heart failure with mildly reduced ejection fraction and myocardial infarction: a multi-institutional cohort study.
机构信息
Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital Chiayi Branch, Chiayi, Taiwan.
Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
出版信息
BMC Cardiovasc Disord. 2023 May 23;23(1):272. doi: 10.1186/s12872-023-03286-9.
BACKGROUND
Little research has been done on ischemic outcomes related to left ventricular ejection fraction (EF) in acute decompensated heart failure (ADHF).
METHODS
A retrospective cohort study was conducted between 2001 and 2021 using the Chang Gung Research Database. ADHF Patients discharged from hospitals between January 1, 2005, and December 31, 2019. Cardiovascular (CV) mortality and heart failure (HF) rehospitalization are the primary outcome components, along with all-cause mortality, acute myocardial infarction (AMI) and stroke.
RESULTS
A total of 12,852 ADHF patients were identified, of whom 2,222 (17.3%) had HFmrEF, the mean (SD) age was 68.5 (14.6) years, and 1,327 (59.7%) were males. In comparison with HFrEF and HFpEF patients, HFmrEF patients had a significant phenotype comorbid with diabetes, dyslipidemia, and ischemic heart disease. Patients with HFmrEF were more likely to experience renal failure, dialysis, and replacement. Both HFmrEF and HFrEF had similar rates of cardioversion and coronary interventions. There was an intermediate clinical outcome between HFpEF and HFrEF, but HFmrEF had the highest rate of AMI (HFpEF, 9.3%; HFmrEF, 13.6%; HFrEF, 9.9%). The AMI rates in HFmrEF were higher than those in HFpEF (AHR, 1.15; 95% Confidence Interval, 0.99 to 1.32) but not in HFrEF (AHR, 0.99; 95% Confidence Interval, 0.87 to 1.13).
CONCLUSION
Acute decompression in patients with HFmrEF increases the risk of myocardial infarction. The relationship between HFmrEF and ischemic cardiomyopathy, as well as optimal anti-ischemic treatment, requires further research on a large scale.
背景
关于射血分数降低的急性失代偿性心力衰竭（ADHF）与左心室射血分数（EF）相关的缺血性结局的研究较少。
方法
这是一项回顾性队列研究，于 2001 年至 2021 年期间在长庚研究数据库中进行。研究对象为 2005 年 1 月 1 日至 2019 年 12 月 31 日期间从医院出院的 ADHF 患者。主要结局包括心血管（CV）死亡率和心力衰竭（HF）再入院，以及全因死亡率、急性心肌梗死（AMI）和中风。
结果
共确定了 12852 例 ADHF 患者，其中 2222 例（17.3%）为 HFmrEF，平均（SD）年龄为 68.5（14.6）岁，1327 例（59.7%）为男性。与 HFrEF 和 HFpEF 患者相比，HFmrEF 患者具有显著的合并糖尿病、血脂异常和缺血性心脏病的表型。HFmrEF 患者更易发生肾衰竭、透析和替代治疗。HFmrEF 和 HFrEF 的电复律和冠状动脉介入治疗率相似。HFpEF 和 HFrEF 之间的临床结局呈中间状态，但 HFmrEF 的 AMI 发生率最高（HFpEF：9.3%；HFmrEF：13.6%；HFrEF：9.9%）。HFmrEF 的 AMI 发生率高于 HFpEF（AHR，1.15；95%置信区间，0.99 至 1.32），但与 HFrEF 无差异（AHR，0.99；95%置信区间，0.87 至 1.13）。
结论
HFmrEF 患者的急性减压会增加心肌梗死的风险。HFmrEF 与缺血性心肌病的关系以及最佳抗缺血治疗需要进一步进行大规模研究。
Zotero 插件