Gottsegen National Cardiovascular Center, Budapest, Hungary.
Division of Non-Invasive Cardiology, Department of Internal Medicine, University of Szeged, Szeged, Hungary.
ESC Heart Fail. 2024 Apr;11(2):783-794. doi: 10.1002/ehf2.14619. Epub 2023 Dec 20.
The aim of the study was to assess the incidence and predictive factors of the development of heart failure with improved ejection fraction (HFimpEF) category during a 1 year follow-up period in a heart failure with reduced ejection fraction (HFrEF) patient population managed in a heart failure outpatient clinic.
The study evaluated data from patients enrolled in the Hungarian Heart Failure Registry (HHFR). The incidence and predictive factors of the development of the HFimpEF category after 1 year follow-up were assessed in the group of patients who had HFrEF at baseline. We evaluated the incidence and predictors of the development of HFimpEF after a 1 year follow-up in relation to time since diagnosis of HFrEF in patients diagnosed within 3 months, between 3 months and 1 year, and beyond 1 year. The predictive factors of the development of HFimpEF were analysed using univariate and multivariate logistic regression analysis. Of the 833 HFrEF patients enrolled in the HHFR, the development of HFimpEF was observed in 162 patients (19.5%) during 1 year follow-up. In the whole patient population, independent predictors of the development of HFimpEF were female gender [odds ratio (OR): 1.73; 95% confidence interval (CI): 1.01-2.96; P < 0.05], non-ischaemic aetiology (OR: 1.95; 95% CI: 1.15-3.30; P < 0.05), and left ventricular end-diastolic diameter (LVEDD) <60 mm (OR: 2.04; 95% CI: 1.18-3.51; P < 0.05). The 1 year incidence of HFimpEF decreased in relation to time since diagnosis of HFrEF. The incidence of HFimpEF was 27.1% in patients diagnosed within 3 months, 18.4% in patients diagnosed between 3 months and 1 year, and 12.2% in patients diagnosed beyond 1 year. Non-ischaemic aetiology (OR: 4.76; 95% CI: 1.83-12.4; P < 0.01) and QRS width (OR: 0.81; 95% CI: 0.71-0.94; P < 0.01) for patients diagnosed within 3 months, LVEDD (OR: 0.54; 95% CI: 0.32-0.90; P < 0.05) and left atrial diameter ≤45 mm (OR: 5.44; 95% CI: 1.45-20.4; P < 0.05) for patients diagnosed between 3 months and 1 year, and LVEDD < 67 mm (OR: 2.71; 95% CI: 1.07-6.88; P < 0.05) for patients diagnosed beyond 1 year were found to be independent predictive factors.
In our study, in this HFrEF patient population managed in a heart failure outpatient clinic, the 1 year incidence of HFimpEF was found to be ~20%. The 1 year incidence of HFimpEF decreased in relation to time since diagnosis of HFrEF. The most important predictors of the development of HFimpEF were female sex, non-ischaemic aetiology, narrower QRS width, and smaller diameter of the left ventricle and left atrium.
本研究旨在评估在心力衰竭门诊管理的射血分数降低心力衰竭（HFrEF）患者人群中，1 年随访期间心力衰竭射血分数改善（HFimpEF）类别的发生率和预测因素。
本研究评估了匈牙利心力衰竭注册研究（HHFR）中患者的数据。在基线时存在 HFrEF 的患者中，评估了 1 年后 HFimpEF 类别的发生率和发展的预测因素。我们评估了在诊断为 HFrEF 后 3 个月内、3 个月至 1 年和 1 年以上的患者中，1 年后 HFimpEF 发展的发生率和预测因素与时间的关系。使用单变量和多变量逻辑回归分析来分析 HFimpEF 发展的预测因素。在纳入 HHFR 的 833 例 HFrEF 患者中，162 例（19.5%）在 1 年随访期间发展为 HFimpEF。在整个患者人群中，HFimpEF 发展的独立预测因素为女性（优势比[OR]：1.73；95%置信区间[CI]：1.01-2.96；P<0.05）、非缺血性病因（OR：1.95；95%CI：1.15-3.30；P<0.05）和左心室舒张末期直径（LVEDD）<60mm（OR：2.04；95%CI：1.18-3.51；P<0.05）。HFimpEF 的 1 年发生率与诊断为 HFrEF 后的时间呈负相关。在诊断为 HFrEF 后 3 个月内的患者中，HFimpEF 的发生率为 27.1%，在诊断为 HFrEF 后 3 个月至 1 年的患者中为 18.4%，在诊断为 HFrEF 后 1 年以上的患者中为 12.2%。非缺血性病因（OR：4.76；95%CI：1.83-12.4；P<0.01）和 QRS 宽度（OR：0.81；95%CI：0.71-0.94；P<0.01）对于在 3 个月内诊断的患者，LVEDD（OR：0.54；95%CI：0.32-0.90；P<0.05）和左心房直径≤45mm（OR：5.44；95%CI：1.45-20.4；P<0.05）对于在 3 个月至 1 年诊断的患者，以及 LVEDD<67mm（OR：2.71；95%CI：1.07-6.88；P<0.05）对于诊断超过 1 年的患者，被发现是独立的预测因素。
在我们的研究中，在心力衰竭门诊管理的 HFrEF 患者人群中，HFimpEF 的 1 年发生率约为 20%。HFimpEF 的 1 年发生率与诊断为 HFrEF 后的时间呈负相关。HFimpEF 发展的最重要预测因素是女性、非缺血性病因、更窄的 QRS 宽度以及左心室和左心房的直径更小。
