心力衰竭伴轻度射血分数降低患者的左心室舒张功能障碍。

Left ventricular diastolic dysfunction in patients with heart failure with mildly reduced ejection fraction.

机构信息

Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany.

Division of Cardiology and Angiology, Heart Center University of Bochum, Bad Oeynhausen 32545, Germany.

出版信息

Int J Cardiol. 2024 Nov 1;414:132386. doi: 10.1016/j.ijcard.2024.132386. Epub 2024 Jul 28.

DOI:10.1016/j.ijcard.2024.132386

PMID:39079587

Abstract

OBJECTIVE

This study investigates the prevalence and prognostic impact of diastolic dysfunction (DD) in patients hospitalized with heart failure (HF) with mildly reduced ejection fraction (HFmrEF) in sinus rhythm.

BACKGROUND

Data regarding the prognostic impact of DD in patients with HFmrEF is limited.

METHODS

From 2016 to 2022, all patients hospitalized with HFmrEF (i.e., left ventricular ejection fraction 41-49% and signs and/or symptoms of HF) were retrospectively included at one institution. Patients with DD were compared to patients without (i.e., non-DD), further risk stratification was performed according to the severity of DD. The primary endpoint was all-cause mortality at 30 months (interquartile range (IQR) 15-61 months), key secondary endpoint was rehospitalization for worsening HF.

RESULTS

From a total of 1154 patients (median age 68 years, 68% males) hospitalized with HFmrEF, concomitant DD was present in 72% (grade I: 56%, grade II: 14%, grade III: 2%). Patients with DD were older (71 years vs. 65 years; p = 0.001) and presented with higher rates of cardiovascular comorbidities. The presence of DD was not associated with the risk of long-term all-cause mortality (adjusted HR = 0.815; 95% CI 0.612-1.085; p = 0.161) or HF-related rehospitalization (adjusted HR = 0.736; 95% CI 0.442-1.225; p = 0.238). Furthermore, the outcome did not differ in patients with more advanced stages of DD.

CONCLUSION

DD is commonly prevalent in patients with HFmrEF, but not associated with long-term prognosis.

摘要

目的

本研究旨在调查窦性节律下心衰伴射血分数轻度降低（HFmrEF）患者中舒张功能障碍（DD）的患病率及其对预后的影响。

背景

关于 HFmrEF 患者 DD 预后影响的数据有限。

方法

2016 年至 2022 年，在一家机构回顾性纳入所有因 HFmrEF（即左心室射血分数 41%-49%和心力衰竭的体征和/或症状）住院的患者。将存在 DD 的患者与不存在 DD 的患者（即非 DD 患者）进行比较，并根据 DD 的严重程度进一步进行危险分层。主要终点为 30 个月（15-61 个月）时的全因死亡率，次要终点为因心力衰竭恶化而再次住院。

结果

在因 HFmrEF 住院的总共 1154 例患者中，72%（I 级：56%，II 级：14%，III 级：2%）存在 DD。DD 患者年龄较大（71 岁 vs. 65 岁；p=0.001），且合并心血管疾病的发生率较高。DD 的存在与长期全因死亡率（校正 HR=0.815；95%CI 0.612-1.085；p=0.161）或心力衰竭相关再住院（校正 HR=0.736；95%CI 0.442-1.225；p=0.238）的风险无关。此外，在 DD 更严重的患者中，结局也无差异。