Division of Cardiovascular Medicine, Department of Internal Medicine Kobe University Graduate School of Medicine Kobe Japan.
Department of Cardiology Hyogo Prefectural Awaji Medical Center Sumoto Japan.
J Am Heart Assoc. 2024 Oct;13(19):e034793. doi: 10.1161/JAHA.124.034793. Epub 2024 Sep 30.
Stage B heart failure (HF) refers to structural heart disease without signs or symptoms of HF, so that early intervention may delay or prevent the onset of overt HF. However, stage B HF is a very broad concept, and risk stratification of such patients can be challenging.
We conducted a prospective study of data for 1646 consecutive patients with HF from the KUNIUMI (Kobe University Heart Failure Registry in Awaji Medical Center) registry chronic cohort. The definition of HF stages was based on current guidelines for classification of 29 patients as stage A HF, 761 as stage B HF, 827 as stage C HF, and 29 patients as stage D HF. The primary end point was the time-to-first-event defined as cardiovascular death or HF hospitalization within 2.0 years of follow-up. A maximum of 6 adjustment factor points was assigned based on Cox proportional hazards analysis findings for the hazard ratio (HR) of independent risk factors for the primary end point: 1 point for anemia, estimated glomerular filtration rate <45 mL/min per 1.73 m, brain natriuretic peptide ≥150 pg/mL, and average ratio of early transmitral flow velocity to early diastolic mitral annular velocity >14, and 2 points for clinical frailty scale >3. Patients with stage B HF were stratified into 3 groups, low risk (0-1 points), moderate risk (2-3 points), and high risk (4-6 points). Based on this scoring system (BEEAF [brain natriuretic peptide, estimated glomerular filtration rate, ratio of early transmitral flow velocity to early diastolic mitral annular velocity, anemia, and frailty]), the outcome was found to become worse in accordance with risk level. High-risk patients with stage B HF and patients with stage C HF showed similar outcomes.
Our scoring system offers an easy-to-use evaluation of risk stratification for patients with stage B HF.
B 期心力衰竭（HF）是指存在结构性心脏病但没有 HF 迹象或症状的情况，因此早期干预可能会延迟或预防显性 HF 的发生。然而，B 期 HF 是一个非常广泛的概念，对这类患者进行风险分层具有挑战性。
我们对来自 KUNIUMI（兵库大学淡路医疗中心心力衰竭注册中心慢性队列）注册研究的 1646 例连续 HF 患者的数据进行了前瞻性研究。HF 分期的定义基于当前指南，将 29 例患者定义为 A 期 HF，761 例患者定义为 B 期 HF，827 例患者定义为 C 期 HF，29 例患者定义为 D 期 HF。主要终点是首次事件时间，定义为 2.0 年随访内心血管死亡或 HF 住院。根据 Cox 比例风险分析结果，为独立于主要终点的危险因素赋值最大 6 个调整因素点：1 个点用于贫血、估计肾小球滤过率<45 mL/min/1.73 m、脑钠肽≥150 pg/mL 和早期二尖瓣瓣口血流速度与早期舒张期二尖瓣环速度比>14，2 个点用于临床虚弱量表>3。B 期 HF 患者分为 3 组：低危（0-1 分）、中危（2-3 分）和高危（4-6 分）。根据该评分系统（BEEAF[脑钠肽、估计肾小球滤过率、早期二尖瓣瓣口血流速度与早期舒张期二尖瓣环速度比、贫血和虚弱]），风险水平越高，结局越差。B 期 HF 高危患者和 C 期 HF 患者的结局相似。
我们的评分系统为 B 期 HF 患者的风险分层提供了一种易于使用的评估方法。
