Kannel W B
Department of Medicine, Boston University School of Medicine/Framingham Heart Study, MA 01701, USA.
Eur J Clin Pharmacol. 1996;49 Suppl 1:S3-9.
Cardiac failure is a lethal end-stage of cardiovascular disease. Survival, once the heart has used up all its reserve and compensatory mechanisms, is little better than for cancer. Once overt failure ensues median survival is only 1.7 years for men and 3.2 years for women, and sudden death is a common mode of exitus. Recent declines in death rates from cardiac disease have not been accompanied by a reduced prevalence or incidence of cardiac failure. A substantial reduction in cardiac failure incidence and mortality requires the detection and correction of presymptomatic left ventricular dysfunction and the risk factors which predispose to its occurrence. Major contributors to the development of cardiac failure have been delineated and quantified. Methods for efficiently identifying presymptomatic candidates for cardiac failure for preventive measures have been developed. High-risk candidates can now be cost-effectively targeted for treatment to delay failure. Independent predictors of heart failure have been identified by epidemiologic research which enable construction of multivariable risk profiles that efficiently predict congestive heart failure (CHF). The conditional probability of an event can be estimated over a wide range using a logistic function including the variables of age, systolic blood pressure, vital capacity, heart rate, ECG-LVH, X-ray cardiac enlargement, glucose intolerance, and coronary heart disease or valvular deformity. In this way it is possible to identify high-risk candidates for CHF. Some 80% of CHF events occur in persons in the upper quintile of multivariate risk. These persons at high risk yield a high prevalence of persons with echocardiographic evidence of impaired cardiac function likely to benefit from vigorous preventive management including angiotensin-converting enzyme (ACE) inhibitors.
心力衰竭是心血管疾病的致命终末期。一旦心脏耗尽其所有储备和代偿机制，其生存率与癌症患者相比并无太大差异。一旦出现明显的心力衰竭，男性的中位生存期仅为1.7年，女性为3.2年，猝死是常见的死亡方式。近期心脏病死亡率的下降并未伴随着心力衰竭患病率或发病率的降低。要大幅降低心力衰竭的发病率和死亡率，需要检测并纠正无症状性左心室功能障碍及其发生的危险因素。导致心力衰竭发生的主要因素已被明确并量化。已开发出有效识别无症状性心力衰竭候选者以采取预防措施的方法。现在可以经济高效地针对高危候选者进行治疗以延缓心力衰竭的发生。通过流行病学研究已确定了心力衰竭的独立预测因素，这使得能够构建多变量风险概况，从而有效地预测充血性心力衰竭（CHF）。使用包含年龄、收缩压、肺活量、心率、心电图左心室肥厚、X线心脏扩大、糖耐量异常以及冠心病或瓣膜畸形等变量的逻辑函数，可以在很宽的范围内估计事件的条件概率。通过这种方式，可以识别出CHF的高危候选者。约80%的CHF事件发生在多变量风险最高五分位数的人群中。这些高危人群中，有超声心动图证据显示心脏功能受损的人患病率很高，他们可能从包括血管紧张素转换酶（ACE）抑制剂在内的积极预防管理中获益。
