Wu Yuzhong, Zhao Jingjing, Chen Chen, Huang Jiale, Liang Weihao, Li Jiayong, Dong Yugang, Liu Chen, Xue Ruicong
Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
Key Laboratory of Assisted Circulation and Vascular Diseases, Chinese Academy of Medical Sciences, Guangzhou, China.
Heart. 2025 Mar 26;111(8):370-377. doi: 10.1136/heartjnl-2024-324517.
Heart failure with preserved ejection fraction is a recognised outcome in patients with myocardial infarction, although heart failure with reduced ejection fraction is more common. Identifying early indicators specific to heart failure with preserved ejection fraction in patients with myocardial infarction could support targeted preventive strategies. This study aimed to determine if pulse pressure and aortic valve peak velocity could serve as early predictors of heart failure with preserved ejection fraction in patients with myocardial infarction.
We retrospectively analysed data from 5188 participants in the Atherosclerosis Risk in Communities Study who were free from heart failure at baseline, including 802 individuals with a history of myocardial infarction. Heart failure events were classified as either heart failure with preserved ejection fraction (left ventricular ejection fraction ≥50%) or heart failure with mildly reduced or reduced ejection fraction (left ventricular ejection fraction <50%). Competing risk regression models were used to examine associations of baseline pulse pressure and aortic valve peak velocity with heart failure subtypes.
Over 6 years of follow-up, 217 cases of heart failure with preserved ejection fraction (including 50 in patients with myocardial infarction) and 127 cases of heart failure with mildly reduced or reduced ejection fraction (33 in patients with myocardial infarction) were identified. Among patients with myocardial infarction, a 1-SD increase in pulse pressure was associated with a 1.60-fold higher risk of heart failure with preserved ejection fraction (95% CI 1.30 to 1.97), and a similar association was observed for aortic valve peak velocity (HR: 1.37, 95% CI 1.19 to 1.58). Patients with pulse pressure ≥68 mm Hg had a 3.83-fold higher risk of heart failure with preserved ejection fraction compared with those with lower pulse pressure, and those with aortic valve peak velocity ≥1.4 m/s had a 2.10-fold higher risk compared with those with lower values. Patients with myocardial infarction with two or more risk factors among elevated pulse pressure, aortic valve peak velocity, diabetes and atrial fibrillation had over 16 times the risk of developing heart failure with preserved ejection fraction compared with those without these risk factors (p<0.001).
Pulse pressure and aortic valve peak velocity are significant predictors of heart failure with preserved ejection fraction in patients with myocardial infarction, suggesting their potential value in early risk stratification. These findings support the use of these markers to guide timely interventions aimed at preventing the progression to heart failure with preserved ejection fraction.
射血分数保留的心力衰竭是心肌梗死患者中已被认可的一种结局，尽管射血分数降低的心力衰竭更为常见。识别心肌梗死患者中射血分数保留的心力衰竭的早期特异性指标有助于制定有针对性的预防策略。本研究旨在确定脉压和主动脉瓣峰值速度是否可作为心肌梗死患者射血分数保留的心力衰竭的早期预测指标。
我们回顾性分析了社区动脉粥样硬化风险研究中5188名基线时无心力衰竭的参与者的数据，其中包括802名有心肌梗死病史的个体。心力衰竭事件分为射血分数保留的心力衰竭（左心室射血分数≥50%）或射血分数轻度降低或降低的心力衰竭（左心室射血分数<50%）。采用竞争风险回归模型来研究基线脉压和主动脉瓣峰值速度与心力衰竭亚型之间的关联。
在6年的随访中，共识别出217例射血分数保留的心力衰竭病例（包括50例心肌梗死患者）和127例射血分数轻度降低或降低的心力衰竭病例（33例心肌梗死患者）。在心肌梗死患者中，脉压每增加1个标准差，射血分数保留的心力衰竭风险升高1.60倍（95%可信区间1.30至1.97），主动脉瓣峰值速度也观察到类似关联（风险比：1.37，95%可信区间1.19至1.58）。脉压≥68 mmHg的患者发生射血分数保留的心力衰竭的风险是脉压较低者的3.83倍，主动脉瓣峰值速度≥1.4 m/s的患者发生射血分数保留的心力衰竭的风险是数值较低者的2.10倍。在心肌梗死患者中，脉压升高、主动脉瓣峰值速度升高、糖尿病和心房颤动这两种或更多危险因素并存的患者发生射血分数保留的心力衰竭的风险是无这些危险因素患者的16倍以上（p<0.001）。
脉压和主动脉瓣峰值速度是心肌梗死患者射血分数保留的心力衰竭的重要预测指标，提示它们在早期风险分层中的潜在价值。这些发现支持使用这些标志物来指导旨在预防进展为射血分数保留的心力衰竭的及时干预。
