射血分数范围内心力衰竭的病因及其与预后的关联

Etiology of Heart Failure Across the Ejection Fraction Spectrum and Association With Prognosis.

作者信息

Kozman Kristian, Ferrannini Giulia, Benson Lina, Dahlström Ulf, Hage Camilla, Savarese Gianluigi, Shahim Bahira, Lund Lars H

机构信息

Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Internal Medicine Unit, Södertälje Hospital, Södertälje, Sweden.

Internal Medicine Unit, Södertälje Hospital, Södertälje, Sweden; Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Stockholm, Sweden.

出版信息

JACC Heart Fail. 2025 Aug;13(8):102491. doi: 10.1016/j.jchf.2025.03.037. Epub 2025 Jun 16.

DOI:10.1016/j.jchf.2025.03.037

PMID:40527152

Abstract

BACKGROUND

The associations between heart failure (HF) etiology and ejection fraction (EF) category and the association between etiology and outcomes in different EF categories are poorly studied.

OBJECTIVES

The aim of this study was to assess differences in etiology and their impact on outcomes in patients with heart failure with reduced ejection fraction (HFrEF), heart failure with mildly reduced ejection fraction (HFmrEF), and heart failure with preserved ejection fraction (HFpEF).

METHODS

Patients enrolled in SwedeHF (Swedish Heart Failure Registry) between April 2010 and December 2023 were included. Patients were categorized according to HF etiology (ischemic, valvular, hypertensive, dilated cardiomyopathy, alcoholic cardiomyopathy, and other) and EF category. The primary outcome was the composite of time to all-cause death and first HF hospitalization. Logistic multinominal regression was used to assess the association between HF etiology and EF category, and Cox regression was used to assess the association between etiology and outcome within each EF category.

RESULTS

Among 73,769 patients with HF (53% HFrEF, 25% HFmrEF, and 22% HFpEF; 38% ischemic, 8% valvular, 25% hypertensive, and 29% other), ischemic etiology was independently associated with HFrEF and HFmrEF, while hypertensive and valvular etiologies were associated with HFpEF. In HFrEF, ischemic etiology was associated with the primary outcome in comparison with all other 3 etiologies. In HFmrEF, hypertensive etiology was associated with first HF hospitalization (HR: 1.10 [95% CI: 1.03-1.19]). In HFpEF, valvular etiology was associated with first HF hospitalization (HR: 1.11 [95% CI: 1.02-1.22]).

CONCLUSIONS

Ischemic etiology was dominant in HFrEF and HFmrEF, while valvular and hypertensive etiologies dominated in HFpEF. Etiologies most associated with death/HF hospitalization were ischemic in HFrEF, hypertensive in HFmrEF, and valvular in HFpEF.

摘要

背景

心力衰竭（HF）病因与射血分数（EF）类别之间的关联，以及不同EF类别中病因与预后之间的关联，目前研究较少。

目的

本研究旨在评估射血分数降低的心力衰竭（HFrEF）、射血分数轻度降低的心力衰竭（HFmrEF）和射血分数保留的心力衰竭（HFpEF）患者病因的差异及其对预后的影响。

方法

纳入2010年4月至2023年12月期间登记在瑞典心力衰竭登记处（SwedeHF）的患者。患者根据HF病因（缺血性、瓣膜性、高血压性、扩张型心肌病、酒精性心肌病和其他）和EF类别进行分类。主要结局是全因死亡时间和首次HF住院的复合结局。采用逻辑多项回归评估HF病因与EF类别之间的关联，采用Cox回归评估各EF类别中病因与结局之间的关联。

结果

在73769例HF患者中（53%为HFrEF，25%为HFmrEF，22%为HFpEF；38%为缺血性，8%为瓣膜性，25%为高血压性，29%为其他），缺血性病因与HFrEF和HFmrEF独立相关，而高血压性和瓣膜性病因与HFpEF相关。在HFrEF中，与所有其他3种病因相比，缺血性病因与主要结局相关。在HFmrEF中，高血压性病因与首次HF住院相关（HR：1.10[95%CI：1.03-1.19]）。在HFpEF中，瓣膜性病因与首次HF住院相关（HR：1.11[95%CI：1.02-1.22]）。