左心室射血分数改善型与持续降低型心力衰竭：BIOSTAT-CHF（欧洲）研究与亚洲心力衰竭注册研究的比较
Heart failure with improved versus persistently reduced left ventricular ejection fraction: A comparison of the BIOSTAT-CHF (European) study with the ASIAN-HF registry.
作者信息
Cao Thong Huy, Tay Wan Ting, Jones Donald J L, Cleland John G F, Tromp Jasper, Emmens Johanna Elisabeth, Teng Tiew-Hwa Katherine, Chandramouli Chanchal, Slingsby Oliver Charles, Anker Stefan D, Dickstein Kenneth, Filippatos Gerasimos, Lang Chim C, Metra Marco, Ponikowski Piotr, Samani Nilesh J, Van Veldhuisen Dirk J, Zannad Faiez, Anand Inder S, Lam Carolyn S P, Voors Adriaan A, Ng Leong L
机构信息
Department of Cardiovascular Sciences, College of Life Sciences, University of Leicester, Leicester, UK.
National Institute for Health and Care Research Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK.
出版信息
Eur J Heart Fail. 2024 Dec;26(12):2518-2528. doi: 10.1002/ejhf.3378. Epub 2024 Aug 9.
AIMS
We investigated the prevalence, clinical characteristics, and prognosis of patients with heart failure (HF) with improved ejection fraction (HFimpEF).
METHODS AND RESULTS
We used data from BIOSTAT-CHF including patients with a left ventricular ejection fraction (LVEF) ≤40% at baseline who had LVEF re-assessed at 9 months. HFimpEF was defined as a LVEF >40% and a LVEF ≥10% increase from baseline at 9 months. We validated findings in the ASIAN-HF registry. The primary outcome was a composite of time to HF rehospitalization or all-cause mortality. In BIOSTAT-CHF, about 20% of patients developed HFimpEF, that was associated with a lower primary event rate of all-cause mortality (hazard ratio [HR] 0.52, 95% confidence interval [CI] 0.28-0.97, p = 0.040) and the composite endpoint (HR 0.46, 95% CI 0.30-0.70, p < 0.001) compared with patients who remained in persistent HF with reduced ejection fraction (HFrEF). The findings were similar in the ASIAN-HF (HR 0.40, 95% CI 0.18-0.89, p = 0.024, and HR 0.29, 95% CI 0.17-0.48, p < 0.001). Five independently common predictors for HFimpEF in both BIOSTAT-CHF and ASIAN-HF were female sex, absence of ischaemic heart disease, higher LVEF, smaller left ventricular end-diastolic and end-systolic diameter at baseline. A predictive model combining only five predictors (absence of ischaemic heart disease and left bundle branch block, smaller left ventricular end-systolic and left atrial diameter, and higher platelet count) for HFimpEF in the BIOSTAT-CHF achieved an area under the curve of 0.772 and 0.688 in the ASIAN-HF (due to missing left atrial diameter and platelet count).
CONCLUSIONS
Approximately 20-30% of patients with HFrEF improved to HFimpEF within 1 year with better clinical outcomes. In addition, the predictive model with clinical predictors could more accurately predict HFimpEF in patients with HFrEF.
目的
我们研究了射血分数改善的心力衰竭（HFimpEF）患者的患病率、临床特征和预后。
方法与结果
我们使用了BIOSTAT-CHF研究中的数据，包括基线时左心室射血分数（LVEF）≤40%且在9个月时重新评估LVEF的患者。HFimpEF定义为LVEF>40%且在9个月时较基线LVEF增加≥10%。我们在亚洲心力衰竭注册研究中验证了研究结果。主要结局是HF再住院时间或全因死亡率的复合终点。在BIOSTAT-CHF研究中，约20%的患者发展为HFimpEF，与仍处于持续性射血分数降低的心力衰竭（HFrEF）患者相比，其全因死亡率的主要事件发生率较低（风险比[HR]0.52，95%置信区间[CI]0.28 - 0.97，p = 0.040），复合终点发生率也较低（HR 0.46，95%CI 0.30 - 0.70，p < 0.001）。在亚洲心力衰竭注册研究中的结果相似（HR 0.40，95%CI = 0.18 - 0.89，p = 0.024；HR 0.29，95%CI 0.17 - 0.48，p < 0.001）。在BIOSTAT-CHF和亚洲心力衰竭注册研究中，HFimpEF的五个独立常见预测因素为女性、无缺血性心脏病、较高的LVEF、基线时较小的左心室舒张末期和收缩末期直径。在BIOSTAT-CHF研究中，仅结合五个预测因素（无缺血性心脏病和左束支传导阻滞、较小的左心室收缩末期和左心房直径、较高的血小板计数）构建的HFimpEF预测模型在亚洲心力衰竭注册研究中的曲线下面积为0.688（由于缺少左心房直径和血小板计数数据），在BIOSTAT-CHF研究中的曲线下面积为0.772。
结论
约20%-30%的HFrEF患者在1年内改善为HFimpEF，临床结局更好。此外，基于临床预测因素的预测模型能够更准确地预测HFrEF患者的HFimpEF。
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