Department for Cardiology, Angiology and Pulmology, University Hospital Heidelberg, Heidelberg, Germany.
Cardiology. 2023;148(6):485-496. doi: 10.1159/000532070. Epub 2023 Jul 29.
The long-term evolution of clinical, echocardiographic, and laboratory parameters of cardiac function in patients with chronic heart failure (HF) with either reduced (HFrEF) or mildly reduced (HFmrEF) left ventricular ejection fraction (LVEF) is incompletely characterised.
We identified patients with chronic stable HF who presented at least twice to a university HF outpatient clinic between 1995 and 2021. Trajectories of NYHA functional class, LVEF, left ventricular internal end-diastolic diameter (LVIDD), NT-proBNP concentrations, and HF treatment over 10 years of follow-up were analysed using fractional polynomials. Analyses were repeated after stratifying patients according to aetiology (ischaemic vs. dilated) or HF category (HFrEF vs. HFmrEF).
A total of 2,132 patients were included, of whom 51% had ischaemic and 49% had dilated HF. Eighty six percent and 14% were classified as HFrEF and HFmrEF, respectively. Mean LVEF was 28 ± 10%, and median NT-proBNP and estimated glomerular filtration rate values were 1,170 (385-3,176) pmol/L and 81 (62-100) mL/min/1.73 m2, respectively. Median follow-up was 5.2 (2.6-9.2) years. Overall, NYHA functional class and LVIDD trajectories were U-shaped, whereas LVEF and NT-proBNP concentrations markedly improved during the first year and remained stable thereafter. However, the evolution of HF parameters significantly differed with respect to HF category and aetiology, with greater improvements seen in patients with HFrEF of non-ischaemic origin. Improvements in HF variables were associated with optimization of HF therapy, notably with initiation and up-titration of renin-angiotensin-system blockers.
This study provides insights into the natural history of HF in a large cohort of well-treated chronic HF outpatients with respect to subgroups of HF and different aetiologists.
患有左心室射血分数（LVEF）降低（HFrEF）或轻度降低（HFmrEF）的慢性心力衰竭（HF）患者的临床、超声心动图和心功能实验室参数的长期演变尚不完全清楚。
我们确定了 1995 年至 2021 年期间至少两次到大学 HF 门诊就诊的慢性稳定 HF 患者。使用分数多项式分析了 10 年随访期间 NYHA 心功能分级、LVEF、左心室舒张末期内径（LVIDD）、NT-proBNP 浓度和 HF 治疗的轨迹。分析后根据病因（缺血性与扩张性）或 HF 类别（HFrEF 与 HFmrEF）对患者进行分层重复分析。
共纳入 2132 例患者，其中 51%为缺血性 HF，49%为扩张性 HF。86%和 14%分别归类为 HFrEF 和 HFmrEF。平均 LVEF 为 28±10%，中位数 NT-proBNP 和估算肾小球滤过率值分别为 1170（385-3176）pmol/L 和 81（62-100）mL/min/1.73 m2。中位随访时间为 5.2（2.6-9.2）年。总体而言，NYHA 心功能分级和 LVIDD 轨迹呈 U 形，而 LVEF 和 NT-proBNP 浓度在第一年显著改善，此后保持稳定。然而，HF 参数的演变在 HF 类别和病因方面存在显著差异，非缺血性起源的 HFrEF 患者的改善更为明显。HF 变量的改善与 HF 治疗的优化相关，尤其是肾素-血管紧张素系统阻滞剂的起始和滴定。
本研究提供了在具有不同 HF 亚组和不同病因的大量经良好治疗的慢性 HF 门诊患者中，HF 的自然史的深入了解。
