Araiza-Garaygordobil Diego, Preciado-Gutierrez Oscar-Ulises, Sierra-Lara Martinez Jorge Daniel, Gonzalez-Pacheco Hector, Gopar-Nieto Rodrigo, Latapi-Ruiz Esparza Ximena, Hernandez-Pastrana Sarai, Diaz-Herrera Braiana-Angeles, Alvarez-Sangabriel Amada, Jordan-Rios Antonio, Arias-Mendoza Alexandra
National Institute of Cardiology Ignacio Chavez, Coronary Care Unit, Mexico City, Mexico.
National Institute of Cardiology Ignacio Chavez, Heart Failure Clinic, Mexico City, Mexico.
Am Heart J Plus. 2024 Nov 23;48:100486. doi: 10.1016/j.ahjo.2024.100486. eCollection 2024 Dec.
Heart failure with preserved ejection fraction (HFpEF) is an increasingly common clinical syndrome, estimated to constitute approximately 50 % of all heart failure (HF) cases. Nonetheless, registries from specific geographic areas, as Latin America, are lacking. The present study aims to report the underlying causes, comorbidities, treatment patterns and outcomes of patients with HFpEF in a large cardiovascular center in Mexico City.
The present is a prospective, longitudinal, observational study, including female and male patients over 18 years of age, who presented to the emergency department, coronary care unit or outpatient department of the National Institute of Cardiology Ignacio Chavez in Mexico City with HFpEF. Patients were classified according to different phenotypes and current literature. The primary outcome was the composite total HFpEF hospitalization and all-cause mortality.
Within a median follow-up of 472 (IQR 425-518) days, total mortality was 14.56 %, with 10.68 % attributed to cardiovascular causes. HF hospitalization was 7.77 %. Atrial fibrillation showed a notable association with outcomes (adjusted HR 2.87, P = 0.028). Beta-blocker showed a non-significant trend towards benefit, while mineralocorticoid receptor antagonists (MRA) significantly influenced outcomes (adjusted HR 3.30, P = 0.018). The primary composite endpoint occurred in 19.42 % of patients, with no significant difference among phenotypes (P = 0.536).
We observed a substantial comorbidity burden impacting quality of life, as indicated by KCCQ scores. There was a high incidence of hard endpoints, including cardiovascular death and hospitalizations, alongside significant variability in treatment utilization. Future research should focus on elucidating individual healthcare trajectories in HFpEF patients and promoting wider adoption of evidence-based therapies.
射血分数保留的心力衰竭（HFpEF）是一种日益常见的临床综合征，估计约占所有心力衰竭（HF）病例的50%。然而，来自特定地理区域（如拉丁美洲）的登记数据却很缺乏。本研究旨在报告墨西哥城一家大型心血管中心HFpEF患者的潜在病因、合并症、治疗模式及预后。
本研究为前瞻性、纵向观察性研究，纳入年龄在18岁以上、因HFpEF就诊于墨西哥城国家心脏病学研究所伊格纳西奥·查韦斯急诊科、冠心病监护病房或门诊的男性和女性患者。根据不同表型和当前文献对患者进行分类。主要结局为HFpEF住院和全因死亡的综合指标。
在中位随访472天（四分位间距425 - 518天）内，总死亡率为14.56%，其中10.68%归因于心血管原因。HF住院率为7.77%。心房颤动与结局显著相关（校正风险比2.87，P = 0.028）。β受体阻滞剂显示出不显著的获益趋势，而盐皮质激素受体拮抗剂（MRA）对结局有显著影响（校正风险比3.30，P = 0.018）。19.42%的患者出现主要复合终点，各表型之间无显著差异（P = 0.536）。
如堪萨斯城心肌病问卷（KCCQ）评分所示，我们观察到大量合并症对生活质量产生影响。包括心血管死亡和住院在内的硬终点发生率较高，治疗应用存在显著差异。未来的研究应聚焦于阐明HFpEF患者的个体医疗轨迹，并促进循证治疗的更广泛应用。
