Okamoto Chisato, Tsukamoto Osamu, Hasegawa Takuya, Hitsumoto Tatsuro, Matsuoka Ken, Amaki Makoto, Kanzaki Hideaki, Izumi Chisato, Takashima Seiji, Ito Shin, Kitakaze Masafumi
Department of Medical Biochemistry, Osaka University Graduate School of Medicine/Frontier Biosciences, Suita, Osaka, Japan.
Department of Clinical Medicine and Development, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
Gastro Hep Adv. 2022 Sep 21;2(2):170-181. doi: 10.1016/j.gastha.2022.09.005. eCollection 2023.
Recognition of heart failure with preserved ejection fraction (HFpEF) at an early stage in mass screening is desirable, but difficult to achieve. We examined whether the fibrosis (Fib)-4 index, a simple index of liver stiffness/fibrosis, could be used as a screening tool to select candidates requiring expert diagnostics.
Individuals who participated in annual health checks between 2006 and 2007 in Arita-cho, Saga, Japan, with no history of cardiovascular disease and EF ≥ 50% were enrolled (total 710; 258 men; median age, 59 years).
Participants were divided into 5 groups according to HFpEF risk: 215 (30%), 100 (14%), 171 (24%), 163 (23%), and 61 (9%) with Heart Failure Association (HFA)-PEFF scores of 0, 1, 2, 3, and 4-6 points, respectively. The highest HFpEF risk group (HFA-PEFF score, 4-6 points) showed poor prognosis for the clinical events of all-cause mortality and hospitalization for HF (log-rank test, = .002). The Fib-4 index was correlated with HFpEF risk stratification (r = 0.526), and increment in the Fib-4 index was independently linked to high HFpEF risk by multiple logistic regression analysis (adjusted odds ratio, 1.311; 95% confidence interval, 1.078-1.595; = .007). The Fib-4 index stratified clinical prognosis (log-rank test, < .001) was an independent predictor of all-cause mortality and hospitalization for HF (hazard ratio, 1.305; 95% confidence interval, 1.139-1.495; < .001).
The Fib-4 index can be used to select appropriate candidates for a detailed examination of HFpEF in a subclinical population.
在大规模筛查中早期识别射血分数保留的心力衰竭（HFpEF）是理想的，但难以实现。我们研究了肝硬度/纤维化的简单指标——Fib-4指数是否可作为一种筛查工具，用于选择需要专家诊断的患者。
纳入2006年至2007年在日本佐贺县有田町参加年度健康检查、无心血管疾病史且射血分数（EF）≥50%的个体（共710例；男性258例；中位年龄59岁）。
根据HFpEF风险将参与者分为5组：心力衰竭协会（HFA）-PEFF评分为0、1、2、3和4 - 6分的分别有215例（30%）、100例（14%）、171例（24%）、163例（23%）和61例（9%）。HFpEF风险最高组（HFA-PEFF评分4 - 6分）在全因死亡率和HF住院等临床事件方面预后较差（对数秩检验，P = 0.002）。Fib-4指数与HFpEF风险分层相关（r = 0.526），通过多因素逻辑回归分析，Fib-4指数的升高与高HFpEF风险独立相关（校正比值比，1.311；95%置信区间，1.078 - 1.595；P = 0.007）。Fib-4指数对临床预后进行分层（对数秩检验，P < 0.001），是全因死亡率和HF住院的独立预测因素（风险比，1.305；95%置信区间，1.139 - 1.495；P < 0.001）。
Fib-4指数可用于在亚临床人群中选择合适的患者进行HFpEF的详细检查。
