基于 HFPEF 评分的肥厚型心肌病患者心力衰竭风险评估。
Heart failure risk assessment in patients with hypertrophic cardiomyopathy based on the HFPEF score.
机构信息
Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands.
First Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
出版信息
Eur J Heart Fail. 2024 Oct;26(10):2173-2182. doi: 10.1002/ejhf.3413. Epub 2024 Aug 27.
AIMS
The aim of this study was to investigate whether the HFPEF score, which was developed to improve the diagnosis of heart failure (HF) with preserved ejection fraction, is associated with HF outcomes in patients with hypertrophic cardiomyopathy (HCM).
METHODS AND RESULTS
Patients with HCM and preserved left ventricular ejection fraction (LVEF ≥50%) were included from a multicentre registry and the HFPEF score was calculated. Patients were divided into three groups: low (0-1), intermediate (2-5) and high (6-9) HFPEF score. The primary combined endpoint was a composite of all-cause death and HF admissions, while the secondary endpoints were all-cause death and HF admissions separately. A total of 955 patients were included (age 51 ± 17 years, 310 [32.5%] female). Patients with a high HFPEF score (n = 105) were more often female, and presented with more symptoms and comorbidities. On echocardiography, patients with a high HFPEF score had lower LVEF, more impaired diastolic function and more frequently left ventricular outflow tract obstruction. During follow-up (median 90 months [interquartile range 49-176]), 103 (11%) patients died and 57 (6%) patients had a first HF hospitalization. Event-free survival rate for the primary combined and secondary endpoints was lower for patients with an intermediate and high HFPEF score. On multivariate Cox regression analysis, female sex (hazard ratio [HR] 1.670, 95% confidence interval [CI] 1.157-2.410; p = 0.006), Asian ethnicity (HR 6.711, 95% CI 4.076-11.048; p < 0.001), ischaemic heart disease (HR 1.732, 95% CI 1.133-2.650; p = 0.011), left atrial diameter (HR 1.028, 95% CI 1.005-1.051; p = 0.016) and intermediate (HR 2.757, 95% CI 1.612-4.713; p < 0.001) or high HFPEF score (HR 3.689, 95% CI 1.908-7.134; p < 0.001) were independently associated with the primary combined endpoint.
CONCLUSION
The HFPEF score is independently associated with HF outcome in patients with HCM and may be considered for risk stratification.
目的
本研究旨在探讨 HFPEF 评分是否与肥厚型心肌病（HCM）患者的射血分数保留型心力衰竭（HF）结局相关，HFPEF 评分是为改善 HF 伴射血分数保留的诊断而开发的。
方法和结果
本研究纳入了来自多中心登记处的射血分数保留（LVEF≥50%）的 HCM 患者，并计算了 HFPEF 评分。患者被分为三组：低（0-1）、中（2-5）和高（6-9）HFPEF 评分组。主要复合终点是全因死亡和 HF 入院的复合终点，次要终点是全因死亡和 HF 入院的单独终点。共纳入 955 例患者（年龄 51±17 岁，310[32.5%]为女性）。HFPEF 评分高（n=105）的患者更常见于女性，且存在更多的症状和合并症。在超声心动图检查中，HFPEF 评分高的患者 LVEF 较低，舒张功能受损更严重，且更常出现左心室流出道梗阻。在中位 90 个月（四分位距 49-176）的随访期间，103 例（11%）患者死亡，57 例（6%）患者首次发生 HF 住院。HFPEF 评分中、高分组的主要复合终点和次要终点的无事件生存率较低。多变量 Cox 回归分析显示，女性（危险比[HR]1.670，95%置信区间[CI]1.157-2.410；p=0.006）、亚洲人种（HR 6.711，95%CI 4.076-11.048；p<0.001）、缺血性心脏病（HR 1.732，95%CI 1.133-2.650；p=0.011）、左心房直径（HR 1.028，95%CI 1.005-1.051；p=0.016）和中（HR 2.757，95%CI 1.612-4.713；p<0.001）或高（HR 3.689，95%CI 1.908-7.134；p<0.001）HFPEF 评分与主要复合终点独立相关。
结论
HFPEF 评分与 HCM 患者的 HF 结局独立相关，可用于风险分层。
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