Goertz Michelle, Schupp Tobias, Dudda Jonas, Weidner Kathrin, Lau Felix, Schmitt Alexander, Abel Noah, Abumayyaleh Mohammad, Steffen Henning Johann, Langer Harald F, Duerschmied Daniel, Akin Ibrahim, Behnes Michael
Department of Cardiology, Haemostaseology, and Medical Intensive Care, Medical Faculty Mannheim, University Medical Centre Mannheim and German Centre for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Heidelberg University, Mannheim, Germany.
Clin Res Cardiol. 2025 Aug 27. doi: 10.1007/s00392-025-02740-2.
Emerging evidence suggests that inflammatory conditions and comorbidities have a prognostic impact on patients with heart failure with mildly reduced ejection fraction (HFmrEF) in particular. This study aims to investigate the influence of rheumatic comorbidities on clinical outcomes in HFmrEF patients.
This retrospective cohort study included patients hospitalized with HFmrEF at a tertiary care center in Germany between January 2016 and December 2022. Patients hospitalized with HFmrEF were divided in two groups - with and without rheumatic diseases - and were compared with regard to the primary endpoint all-cause mortality at 30 months, as well as the key secondary endpoint HF-related rehospitalization.
From a total of 2,184 patients with HFmrEF, 47 (2.2%) were diagnosed with a rheumatic disease. There was no significant difference in distribution of age (median 75 years vs. 76 years, p = 0.532), sex (males: 55.3% vs. 64.8%; p = 0.181) and cardiovascular comorbidities between patients with and without rheumatic diseases. The presence of rheumatic disease was not associated with the risk of all-cause mortality at 30 months (HR = 0.765; 95% CI 0.432-1.354; p = 0.358). However, patients with rheumatic diseases were associated with a higher risk of rehospitalization for HF at 30 months (HR = 2.088; 95% CI 1.171-3.723; p = 0.013). This association was still observed after multivariable adjustment (HR = 2.360; p = 0.006).
Patients with HFmrEF and coexisting rheumatic diseases did not exhibit increased 30-month all-cause mortality. However, the risk of rehospitalization was significantly higher in patients with rheumatic diseases.
新出现的证据表明，炎症性疾病和合并症尤其对射血分数轻度降低的心力衰竭（HFmrEF）患者的预后有影响。本研究旨在调查风湿性合并症对HFmrEF患者临床结局的影响。
这项回顾性队列研究纳入了2016年1月至2022年12月期间在德国一家三级医疗中心因HFmrEF住院的患者。因HFmrEF住院的患者分为两组——患有和未患有风湿性疾病——并就30个月时的主要终点全因死亡率以及关键次要终点与心力衰竭相关的再住院情况进行比较。
在总共2184例HFmrEF患者中，47例（2.2%）被诊断患有风湿性疾病。患有和未患有风湿性疾病的患者在年龄分布（中位数75岁对76岁，p = 0.532）、性别（男性：55.3%对64.8%；p = 0.181）和心血管合并症方面无显著差异。风湿性疾病的存在与30个月时的全因死亡率风险无关（HR = 0.765；95%CI 0.432 - 1.354；p = 0.358）。然而，患有风湿性疾病的患者在30个月时因心力衰竭再住院的风险更高（HR = 2.088；95%CI 1.171 - 3.723；p = 0.013）。多变量调整后仍观察到这种关联（HR = 2.360；p = 0.006）。
患有HFmrEF且并存风湿性疾病的患者30个月全因死亡率未增加。然而，患有风湿性疾病的患者再住院风险显著更高。
