Mourmans Sanne G J, Weerts Jerremy, Baumert Mathias, Aizpurua Arantxa Barandiarán, Achten Anouk, Knackstedt Christian, Linz Dominik, van Empel Vanessa P M
Department of Cardiology, CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.
Discipline of Biomedical Engineering, School of Electrical and Mechanical Engineering, University of Adelaide, North Terrace, Adelaide, Australia.
ESC Heart Fail. 2025 Feb;12(1):622-630. doi: 10.1002/ehf2.15116. Epub 2024 Oct 27.
Nocturnal hypoxaemic burden, quantified as time spent with oxygen saturation below 90% (T90), is an established independent predictor of mortality in heart failure (HF) with reduced ejection fraction. The prognostic value of T90 in HF with preserved ejection fraction (HFpEF) is unknown. This study aims to determine the association of T90 with adverse outcomes in HFpEF.
One hundred twenty-six patients prospectively included from our specialised HFpEF outpatient clinic underwent ambulatory home sleep monitoring to obtain oximetry data, including T90. We investigated the association between T90 and a composite endpoint of HF hospitalisations or all-cause mortality. Nocturnal hypoxaemic burden in this HFpEF population was high, with a median T90 of 13.7 min. In only 10 patients (7.9%), oxygen saturation was at no time point below 90%. After median 34 months [IQR 18.4-52.0] of follow-up, 32 patients (25%) reached the composite endpoint. T90 was significantly associated with the composite endpoint, also after adjusting for potential confounders (HR 1.004 (95% CI 1.001-1.007, P = 0.019) per 1 min T90 increase or HR 1.265 (95% CI 1.061-1.488) per 1 h T90 increase). Patients with HFpEF in the highest T90 tertile (T90 ≥ 31.4 min) had a significantly higher event rate compared to patients in the lowest two T90 tertiles, with 19 (45%) versus 13 (15%) events, respectively (P < 0.001).
Nocturnal hypoxaemic burden is an independent prognostic marker for the composite of HF hospitalisations or all-cause mortality in HFpEF. Whether reduction of T90 improves the prognosis of patients with HFpEF warrants further research.
夜间低氧血症负荷，以氧饱和度低于90%的时长（T90）来量化，是射血分数降低的心力衰竭（HF）患者死亡率的既定独立预测因素。T90在射血分数保留的心力衰竭（HFpEF）中的预后价值尚不清楚。本研究旨在确定T90与HFpEF不良结局之间的关联。
前瞻性纳入我们专科HFpEF门诊的126例患者，进行家庭动态睡眠监测以获取血氧饱和度数据，包括T90。我们研究了T90与HF住院或全因死亡的复合终点之间的关联。该HFpEF人群的夜间低氧血症负荷较高，T90中位数为13.7分钟。仅10例患者（7.9%）的氧饱和度在任何时间点均未低于90%。经过中位数34个月[四分位间距18.4 - 52.0]的随访，32例患者（25%）达到复合终点。T90与复合终点显著相关，在调整潜在混杂因素后也是如此（每增加1分钟T90，风险比[HR]为1.004（95%置信区间[CI] 1.001 - 1.007，P = 0.019）；或每增加1小时T90，HR为1.265（95% CI 1.061 - 1.488））。T90处于最高三分位数（T90≥31.4分钟）的HFpEF患者与最低两个三分位数的患者相比，事件发生率显著更高，分别为19例（45%）和13例（15%）（P < 0.001）。
夜间低氧血症负荷是HFpEF患者HF住院或全因死亡复合终点的独立预后标志物。降低T90是否能改善HFpEF患者的预后值得进一步研究。
