射血分数保留的心力衰竭的早期诊断及病情进展评估：一项针对动脉高血压和左心室肥厚患者的回顾性研究

Evaluation of early diagnosis and progression to heart failure with preserved ejection fraction: A retrospective study in patients with arterial hypertension and left ventricular hypertrophy.

作者信息

Kassab Vivian P, Oldra Leonardo G O, Milanesi Gabriele S, de Souza Francis R, Bortolotto Luiz A, Fonseca Guilherme W P, Alves Maria-Janieire de N N, Kalil-Filho Roberto

机构信息

Heart Institute (InCor), University of São Paulo Medical School, Department of Cardiopulmonology, São Paulo, Brazil.

出版信息

Int J Cardiol. 2025 Dec 1;440:133672. doi: 10.1016/j.ijcard.2025.133672. Epub 2025 Aug 7.

DOI:10.1016/j.ijcard.2025.133672

PMID:40754112

Abstract

BACKGROUND

Heart failure with preserved ejection fraction (HFpEF) accounts for 50 % of all heart failure cases. The HFPEF score, used to estimate HFpEF probability, incorporates factors such as Heavy, Hypertensive, Atrial Fibrillation, Elder, and Filling Pressure. Left ventricle hypertrophy (LVH) and left atrial (LA) enlargement has been associated to HFpEF, though the role of myocardial thickening and LAE on progression of this condition is not fully understood.

OBJECTIVES

To evaluate correlation of cardiac function and structure obtained by echocardiogram, presence of comorbidities, b-type natriuretic peptide and the probability of HFpEF evaluated by HFPEF score in patients with arterial hypertension (AH) and LVH without diagnosis of HFpEF.

METHODS

Retrospective data obtained from medical records of 118 hypertensive patients with LV ejection fraction ≥55 %, septum wall thickness (SWT) and LV posterior wall >9 mm were evaluated. The patients were divided into 2 groups: SWT ≥ 13 mm (moderate/severe hypertrophy) and SWT <13 mm (mildly abnormal hypertrophy). HFPEF score was used to classify the patients: score < 6 (low probability of HFpEF) and score ≥ 6 (high probability of HFpEF). Comorbidities, such as obesity and diabetes were also evaluated.

RESULTS

LA (AUC 0.657; 95 %CI, 0.551-0.763; p = 0.010; cutoff value 37.50), sensitivity 96.7 % and specificity 84.8 % was the best independent predictor of HFpEF. BMI (AUC 0.766; 95 %CI, 0.664-0.868; p = 0.001), cutoff value of 21.655, sensitivity of 96,7 % and specificity of 81,8 % also showed a significant association.

CONCLUSION

Patients with AH and LVH, LA enlargement was associated with higher probability of HFpEF by HFPEF score, which could improve early diagnosis and risk stratification.

摘要

背景

射血分数保留的心力衰竭（HFpEF）占所有心力衰竭病例的50%。用于估计HFpEF概率的HFPEF评分纳入了诸如肥胖、高血压、心房颤动、老年和充盈压等因素。左心室肥厚（LVH）和左心房（LA）扩大与HFpEF相关，尽管心肌增厚和左心房扩大在该疾病进展中的作用尚未完全明确。

目的

评估在未诊断为HFpEF的动脉高血压（AH）和LVH患者中，通过超声心动图获得的心脏功能和结构、合并症的存在、b型利钠肽以及通过HFPEF评分评估的HFpEF概率之间的相关性。

方法

回顾性分析118例左心室射血分数≥55%、室间隔厚度（SWT）和左心室后壁>9mm的高血压患者的病历资料。患者分为两组：SWT≥13mm（中度/重度肥厚）和SWT<13mm（轻度异常肥厚）。使用HFPEF评分对患者进行分类：评分<6（HFpEF概率低）和评分≥6（HFpEF概率高）。还评估了肥胖和糖尿病等合并症。

结果

左心房（AUC 0.657；95%CI，0.551 - 0.763；p = 0.010；临界值37.50），敏感性96.7%，特异性84.8%，是HFpEF的最佳独立预测因子。体重指数（AUC 0.766；95%CI，0.664 - 0.868；p = 0.001），临界值21.655，敏感性96.7%，特异性81.8%，也显示出显著相关性。