Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan.
Division of Cardiology, Osaka General Medical Center, Osaka, Japan.
ESC Heart Fail. 2024 Jun;11(3):1758-1766. doi: 10.1002/ehf2.14734. Epub 2024 Mar 8.
Low-density lipoprotein cholesterol (LDL-C), anaemia and low platelets have been associated with worse clinical outcomes in heart failure patients. We investigated the relationship between the combination of these three components and clinical outcome in patients with heart failure with preserved ejection fraction (HFpEF).
We examined the data of 1021 patients with HFpEF hospitalized with acute decompensated heart failure (HF) from the PURSUIT-HFpEF registry, a prospective, multicenter observational study. The enrolled patients were classified into four groups by an LEP (LDL-C, Erythrocyte, and Platelet) score of 0 to 3 points, with 1 point each for LDL-C, erythrocyte and platelet values less than the cut-off values as calculated by receiver operating characteristic curve analysis. The endpoint, a composite of all-cause death and HF readmission, was evaluated among the four groups. Median follow-up duration was 579 [300, 978] days. Risk of the composite endpoint significantly differed among the four groups (P < 0.001). Kaplan-Meier analysis showed that the groups with an LEP score of 2 had higher risk of the composite endpoint than those with an LEP score of 0 or 1 (P < 0.001, and P = 0.013, respectively), while those with an LEP score of 3 had higher risk than those with an LEP score of 0, 1 or 2 (P < 0.001, P < 0.001 and P = 0.020, respectively). Cox proportional hazards analysis showed that an LEP score of 3 was significantly associated with the composite endpoint (P = 0.030). Kaplan-Meier analysis showed that risk of the composite of all-cause death and HF readmission was significantly higher in low LDL values (less than the cut-off values as calculated by receiver operating characteristic curve analysis) patients with statin use than in those without statin use (log rank P = 0.002).
LEP score, which comprehensively reflects extra-cardiac co-morbidities, is significantly associated with clinical outcomes in HFpEF patients.
低密度脂蛋白胆固醇（LDL-C）、贫血和血小板减少与心力衰竭患者的临床预后不良相关。我们研究了这三种成分组合与射血分数保留的心力衰竭（HFpEF）患者临床结局之间的关系。
我们检查了来自前瞻性、多中心观察性研究 PURSUIT-HFpEF 登记处的 1021 例急性失代偿性心力衰竭（HF）住院的 HFpEF 患者的数据。根据 LDL-C、红细胞和血小板值小于通过接受者操作特征曲线分析计算的截止值的 LEP（LDL-C、红细胞和血小板）评分 0 至 3 分，将入组患者分为四组。评估了四组的终点，即全因死亡和 HF 再入院的复合终点。中位随访时间为 579 [300, 978] 天。四组之间复合终点的风险差异有统计学意义（P<0.001）。Kaplan-Meier 分析显示，LEP 评分 2 的组比 LEP 评分 0 或 1 的组发生复合终点的风险更高（P<0.001，P=0.013），而 LEP 评分 3 的组比 LEP 评分 0、1 或 2 的组发生复合终点的风险更高（P<0.001，P<0.001，P=0.020）。Cox 比例风险分析显示，LEP 评分 3 与复合终点显著相关（P=0.030）。Kaplan-Meier 分析显示，在使用他汀类药物的 LDL 值较低（低于通过接受者操作特征曲线分析计算的截止值）的患者中，全因死亡和 HF 再入院的复合终点风险明显高于未使用他汀类药物的患者（对数秩 P=0.002）。
综合反映心脏外合并症的 LEP 评分与 HFpEF 患者的临床结局显著相关。
