Su Jingjing, Su Kangkang, Song Yanping, Hao Lihui, Wang Yitao, Chen Shuxia, Gu Jian
School of Medicine, Graduate School of Hebei Medical University, 050017 Shijiazhuang, Hebei, China.
Department of Heart Center, Hebei General Hospital, 050051 Shijiazhuang, Hebei, China.
Rev Cardiovasc Med. 2024 May 20;25(5):177. doi: 10.31083/j.rcm2505177. eCollection 2024 May.
Recent studies have indicated that heart failure (HF) with preserved ejection fraction (HFpEF) within different left ventricular ejection fraction (LVEF) ranges presents distinct morphological and pathophysiological characteristics, potentially leading to diverse prognoses.
We included chronic HF patients hospitalized in the Department of Cardiology at Hebei General Hospital from January 2018 to June 2021. Patients were categorized into four groups based on LVEF: HF with reduced ejection fraction (HFrEF, LVEF 40%), HF with mildly reduced ejection fraction (HFmrEF, 41% LVEF 49%), low LVEF-HFpEF (50% LVEF 60%), and high LVEF-HFpEF (LVEF 60%). Kaplan‒Meier curves were plotted to observe the occurrence rate of endpoint events (all-cause mortality and cardiovascular mortality) within a 2-year period. Cox proportional hazards regression models were employed to predict the risk factors for endpoint events. Sensitivity analyses were conducted using propensity score matching (PSM), and Fine-Gray tests were used to evaluate competitive risk.
A total of 483 chronic HF patients were ultimately included. Kaplan‒Meier curves indicated a lower risk of endpoint events in the high LVEF-HFpEF group than in the low LVEF-HFpEF group. After PSM, there were still statistically significant differences in endpoint events between the two groups (all-cause mortality = 0.048, cardiovascular mortality = 0.027). Body mass index (BMI), coronary artery disease, cerebrovascular disease, hyperlipidemia, hypoalbuminemia, and diuretic use were identified as independent risk factors for all-cause mortality in the low LVEF-HFpEF group ( 0.05). Hyperlipidemia, the estimated glomerular filtration rate (eGFR), and -blocker use were independent risk factors for cardiovascular mortality ( 0.05). In the high LVEF-HFpEF group, multivariate Cox regression analysis revealed that age, smoking history, hypoalbuminemia, and the eGFR were independent risk factors for all-cause mortality, while age, heart rate, blood potassium level, and the eGFR were independent risk factors for cardiovascular mortality ( 0.05). After controlling for competitive risk, cardiovascular mortality risk remained higher in the low LVEF-HFpEF group than in the high LVEF-HFpEF group (Fine-Gray 0.01).
Low LVEF-HFpEF and high LVEF-HFpEF represent two distinct phenotypes of HFpEF. Patients with high LVEF-HFpEF have lower risks of both all-cause mortality and cardiovascular mortality than those with low LVEF-HFpEF. The therapeutic reduction in blood volume may not be the best treatment option for patients with high LVEF-HFpEF.
近期研究表明，不同左心室射血分数（LVEF）范围内的射血分数保留的心力衰竭（HFpEF）呈现出不同的形态学和病理生理学特征，可能导致不同的预后。
我们纳入了2018年1月至2021年6月在河北医科大学附属第二医院心内科住院的慢性HF患者。根据LVEF将患者分为四组：射血分数降低的心力衰竭（HFrEF，LVEF＜40%）、射血分数轻度降低的心力衰竭（HFmrEF，41%≤LVEF≤49%）、低LVEF-HFpEF（50%≤LVEF≤60%）和高LVEF-HFpEF（LVEF＞60%）。绘制Kaplan-Meier曲线以观察2年内终点事件（全因死亡率和心血管死亡率）的发生率。采用Cox比例风险回归模型预测终点事件的危险因素。使用倾向评分匹配（PSM）进行敏感性分析，并使用Fine-Gray检验评估竞争风险。
最终共纳入483例慢性HF患者。Kaplan-Meier曲线表明，高LVEF-HFpEF组的终点事件风险低于低LVEF-HFpEF组。PSM后，两组终点事件仍存在统计学显著差异（全因死亡率P = 0.048，心血管死亡率P = 0.027）。体重指数（BMI）、冠状动脉疾病、脑血管疾病、高脂血症、低白蛋白血症和使用利尿剂被确定为低LVEF-HFpEF组全因死亡率的独立危险因素（P＜0.05）。高脂血症、估算肾小球滤过率（eGFR）和使用β受体阻滞剂是心血管死亡率的独立危险因素（P＜0.05）。在高LVEF-HFpEF组中，多因素Cox回归分析显示，年龄、吸烟史、低白蛋白血症和eGFR是全因死亡率的独立危险因素，而年龄、心率、血钾水平和eGFR是心血管死亡率的独立危险因素（P＜0.05）。在控制竞争风险后，低LVEF-HFpEF组的心血管死亡风险仍高于高LVEF-HFpEF组（Fine-Gray P＜0.01）。
低LVEF-HFpEF和高LVEF-HFpEF代表HFpEF的两种不同表型。高LVEF-HFpEF患者的全因死亡率和心血管死亡率均低于低LVEF-HFpEF患者。对于高LVEF-HFpEF患者，减少血容量的治疗可能不是最佳治疗选择。
