Department of Cardiology, Herlev and Gentofte Hospital, Hellerup, Denmark
Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark.
Heart. 2023 Dec 15;110(1):49-56. doi: 10.1136/heartjnl-2023-322371.
Identifying clinical and echocardiographic parameters associated with improvement in systolic function in outpatients with heart failure with reduced ejection fraction (HFrEF) could lead to more targeted treatment improving systolic function and outcome.
In a retrospective cohort study, echocardiographic examinations from the first and final visit of 686 patients with HFrEF at the heart failure clinic at Gentofte Hospital were retrieved and analysed. Parameters associated with left ventricular ejection fraction (LVEF) improvement and survival according to LVEF improvement were assessed using linear regression and Cox regression, respectively. Beta-coefficients (β-coef) are standardised. Strain values are absolute.
While undergoing heart failure treatment, 559 (81.5%) patients improved systolic function ( Δ LVEF >0%), with 100 (14.6%) being super responders defined by LVEF improvement >20%. After multivariable adjustment, LVEF improvement was significantly associated with a less impaired global longitudinal strain (β-coef 0.25, p<0.001), higher tricuspid annular plane systolic excursion (β-coef 0.09, p=0.018), smaller left ventricular internal dimension in diastole (β-coef -0.15, p=0.011), lower E-wave/A-wave ratio (β-coef -0.13, p=0.003), higher heart rate (β-coef 0.18, p<0.001) and absence of ischaemic cardiomyopathy (β-coef -0.11, p=0.010) and diabetes (β-coef -0.081, p=0.033) at baseline. Mortality incidence rates differed with LVEF improvement ( Δ LVEF <0% vs Δ LVEF >0%, 8.3 vs 4.3 per 100 person years, p=0.012). Greater improvement in LVEF was associated with significantly lower mortality risk (tertile 1 vs tertile 3, HR 3.23, 95% CI 1.39 to 7.51, p=0.006).
In this outpatient HFrEF cohort, most patients improved systolic function. Heart failure aetiology, comorbidities and echocardiographic measures of heart structure and function were significantly, independently associated with future LVEF improvement. Greater LVEF improvement was significantly associated with lower mortality.
确定与射血分数降低的心力衰竭（HFrEF）门诊患者收缩功能改善相关的临床和超声心动图参数，可能会导致针对收缩功能和预后改善的更具针对性的治疗。
在一项回顾性队列研究中，检索了Gentofte 医院心力衰竭诊所首次和最后一次就诊的 686 例 HFrEF 患者的超声心动图检查，并进行了分析。使用线性回归和 Cox 回归分别评估与左心室射血分数（LVEF）改善相关的参数和根据 LVEF 改善的生存情况。β-系数（β- coef）是标准化的。应变值是绝对值。
在接受心力衰竭治疗期间，559 例（81.5%）患者收缩功能改善（Δ LVEF >0%），其中 100 例（14.6%）为 LVEF 改善>20%的超级应答者。多变量调整后，LVEF 改善与全球纵向应变受损程度降低显著相关（β- coef 0.25，p<0.001），三尖瓣环平面收缩期位移升高（β- coef 0.09，p=0.018），舒张期左心室内径减小（β- coef -0.15，p=0.011），E 波/A 波比值降低（β- coef -0.13，p=0.003），心率升高（β- coef 0.18，p<0.001），以及基线时无缺血性心肌病（β- coef -0.11，p=0.010）和糖尿病（β- coef -0.081，p=0.033）。死亡率发生率与 LVEF 改善不同（Δ LVEF <0%与 Δ LVEF >0%，每 100 人年分别为 8.3 例和 4.3 例，p=0.012）。LVEF 更大的改善与显著降低的死亡率风险相关（三分位 1 与三分位 3，HR 3.23，95%CI 1.39 至 7.51，p=0.006）。
在这个门诊 HFrEF 队列中，大多数患者收缩功能得到改善。心力衰竭病因、合并症以及心脏结构和功能的超声心动图指标与未来的 LVEF 改善显著相关。LVEF 更大的改善与更低的死亡率显著相关。
