Meng Weilun, Yang Haotian, Ren Zhongyuan, Wu Jiawen, Zheng Yixing, Zhao Song, Xu Chong, Maimaitiaili Rusitanmujiang, Tang Jiamin, Yu Shikai, Xiong Jing, Chi Chen, Xu Yawei, Zhang Yi
Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
Department of Cardiology, Shanghai Putuo District People's Hospital, Shanghai, China.
ESC Heart Fail. 2025 Feb;12(1):229-238. doi: 10.1002/ehf2.15060. Epub 2024 Sep 12.
Heart failure with preserved ejection fraction (HFpEF) is a growing concern among the elderly population, significantly impacting morbidity and mortality rates. This study aimed to screen and investigate the characteristics and prognosis of early-stage HFpEF in the elderly.
A total of 1789 community-dwelling individuals aged over 65 from northern Shanghai were enrolled. According to American Heart Association (AHA) guidelines, participants were classified into four groups: HFpEF stage 0, HFpEF stage A, HFpEF stage B and HFpEF stage C. Major endpoints included major adverse cardiovascular events (MACEs), all-cause death and cardiovascular death.
After a mean follow-up period of 7.10 ± 1.27 years, 1623 elderly subjects were included [HFpEF stage 0 (10.3%), HFpEF stage A (16.3%), HFpEF stage B (60.6%) and HFpEF stage C (12.8%)]. Patients with HFpEF stage A, HFpEF stage B and HFpEF stage C exhibited more MACEs than those in HFpEF stage 0 (P < 0.01). Patients with HFpEF stage C had a significantly higher cardiovascular (P < 0.001) and all-cause death ratio (P < 0.01). With HFpEF stage 0 as a reference, the increases in MACEs were significantly associated with HFpEF stage A [hazard ratio (HR): 2.97, 95% confidence interval (CI) (1.13, 7.82), P < 0.05], HFpEF stage B [HR: 2.69, 95% CI (1.09, 6.64), P < 0.05] and HFpEF stage C [HR: 4.86, 95% CI (1.88, 12.59), P < 0.01] in the Cox regression analysis. Our finding remains unaltered in the sensitivity analysis, with no interaction for effectiveness.
Compared with those with HFpEF stage 0, patients with HFpEF, whether in stage B or C, exhibit significantly higher cardiovascular and all-cause mortality in the elderly. This study underscores the importance of early-stage HFpEF screening, particularly in older, asymptomatic stage B individuals.
射血分数保留的心力衰竭（HFpEF）在老年人群中日益受到关注，对发病率和死亡率有重大影响。本研究旨在筛查和调查老年人早期HFpEF的特征及预后。
纳入了1789名来自上海北部社区、年龄超过65岁的居民。根据美国心脏协会（AHA）指南，参与者被分为四组：HFpEF 0期、HFpEF A期、HFpEF B期和HFpEF C期。主要终点包括主要不良心血管事件（MACE）、全因死亡和心血管死亡。
平均随访7.10±1.27年后，纳入了1623名老年受试者[HFpEF 0期（10.3%）、HFpEF A期（16.3%）、HFpEF B期（60.6%）和HFpEF C期（12.8%）]。HFpEF A期、HFpEF B期和HFpEF C期的患者比HFpEF 0期的患者表现出更多的MACE（P<0.01）。HFpEF C期的患者心血管死亡率（P<0.001）和全因死亡率（P<0.01）显著更高。以HFpEF 0期为参照，在Cox回归分析中，MACE的增加与HFpEF A期[风险比（HR）：2.97，95%置信区间（CI）（1.13，7.82），P<0.05]、HFpEF B期[HR：2.69，95%CI（1.09，6.64），P<0.05]和HFpEF C期[HR：4.86，95%CI（1.88，12.59），P<0.01]显著相关。在敏感性分析中我们的发现保持不变，有效性无交互作用。
与HFpEF 0期患者相比，HFpEF患者，无论处于B期还是C期，在老年人中都表现出显著更高的心血管死亡率和全因死亡率。本研究强调了早期HFpEF筛查的重要性，特别是在年龄较大、无症状的B期个体中。
