Rowe Stephanie J, Xiang Ruidong, Paratz Elizabeth D, Takeuchi Fumihiko, La Gerche Andre
Heart, Exercise and Research Trials (HEART) Lab, St Vincent's Institute of Medical Research, Fitzroy, Victoria, Australia; Department of Cardiology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; The University of Melbourne, Parkville, Victoria, Australia.
The University of Melbourne, Parkville, Victoria, Australia; Baker Heart and Diabetes Institute, Melbourne, Australia.
Int J Cardiol. 2025 Jan 15;419:132687. doi: 10.1016/j.ijcard.2024.132687. Epub 2024 Oct 28.
Previous studies suggest that prevalent heart failure (HF) differs based on left ventricular ejection fraction (LVEF) and left ventricular (LV) chamber size. Furthermore, the prevalence of HF with preserved ejection fraction (HFpEF) is often considered approaching, or exceeding that of HF with reduced ejection fraction in the community.
The aim of this study was to evaluate prevalent and incident HF based on LVEF and CMR-determined LV size within a large community-dwelling cohort.
Individuals from the United Kingdom Biobank (UKB) who underwent CMR and had available health record linkage to allow ascertainment of HF diagnosis were included. The cohort was analysed according to LVEF, LV end-diastolic volume (LVEDV) quartiles and LVEDV indexed to body surface area (LVEDVi).
38,129 individuals were included, comprising those with reduced LVEF (LVEF<50 %, n = 5096) and preserved LVEF (LVEF 50-60 %, n = 22,907, LVEF≥60 %, n = 10,126). Prevalent HF was highest in males with LVEF<50 %, and participants with reduced LVEF had higher rates of incident HF (p < 0.001) during the follow-up period (median = 2.46 years from CMR). Mean LVEDV and LVEDVi were largest in individuals with EF < 50 % (146.9 ± 36.2 ml and 76.8 ± 16.4 ml/m respectively). Compared to the smallest quartiles, the largest quartiles for LVEDV were associated with increased odds of HF (odds ratio 2.14 [95 % confidence interval 1.47-3.12], p < 0.001).
Over 50 % of HF cases occur in individuals with LVEF ≥50 %, however HF prevalence is highest in those with reduced LVEF, particularly in males. Larger LV size is associated with increased HF across the LVEF spectrum.
既往研究表明，根据左心室射血分数（LVEF）和左心室（LV）腔大小，心力衰竭（HF）的患病率存在差异。此外，在社区中，射血分数保留的心力衰竭（HFpEF）的患病率通常被认为接近或超过射血分数降低的心力衰竭。
本研究旨在评估一个大型社区居住队列中基于LVEF和心脏磁共振成像（CMR）测定的左心室大小的HF患病率和发病率。
纳入英国生物银行（UKB）中接受CMR检查且有可用健康记录链接以确定HF诊断的个体。根据LVEF、左心室舒张末期容积（LVEDV）四分位数和体表面积指数化的LVEDV（LVEDVi）对队列进行分析。
共纳入38129名个体，包括LVEF降低者（LVEF<50%，n=5096）和LVEF保留者（LVEF 50-60%，n=22907，LVEF≥60%，n=10126）。LVEF<50%的男性中HF患病率最高，LVEF降低的参与者在随访期间（CMR后中位时间=2.46年）HF发病率更高（p<0.001）。EF<50%的个体平均LVEDV和LVEDVi最大（分别为146.9±36.2 ml和76.8±16.4 ml/m²）。与最小四分位数相比，LVEDV最大四分位数与HF发生几率增加相关（优势比2.14[95%置信区间1.47-3.12]，p<0.001）。
超过50%的HF病例发生在LVEF≥50%的个体中，然而LVEF降低者中HF患病率最高，尤其是男性。在整个LVEF范围内，较大的左心室大小与HF增加相关。
