Elucidation of the Strongest Predictors of Cardiovascular Events in Patients with Heart Failure.
Elucidation of the Strongest Predictors of Cardiovascular Events in Patients with Heart Failure.
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DOI：
10.1016/j.ebiom.2018.06.001
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发表时间：
2018-07
期刊：
影响因子：
11.1
通讯作者：
Kitakaze M
中科院分区：
文献类型：
--
作者：
Fukuda H;Shindo K;Sakamoto M;Ide T;Kinugawa S;Fukushima A;Tsutsui H;Ito S;Ishii A;Washio T;Kitakaze M
在先前的回顾性研究中，我们确定了心力衰竭（HF）患者心血管结局的50个最有影响力的临床预测因子。本研究的目的是使用新的有限多元检验程序来筛选这50个临床因素，从而产生不超过4个因素的组合，这些因素可能预测心血管事件的发生。Kaplan-Meier分析用于研究组合的重要性。在一项多中心观察性试验中，我们前瞻性入组了213例因急性加重住院的HF患者，根据HF治疗指南出院，并观察监测心血管事件。观察期后，我们根据患者是否发生心血管事件（再住院或心血管死亡）对患者进行分层。在少于5个临床参数的77，562种组合中，我们确定了151种可能解释心血管事件发生的组合。其中，145个组合包括使用正性肌力药物，而其余6个组合包括使用利尿剂，无心动过缓或心动过速，表明心血管事件的高概率完全由这两个临床因素决定。重要的是，Kaplan-Meier曲线表明，使用正性肌力药或利尿剂而不出现心动过缓或心动过速是心血管预后明显恶化的独立预测因素。接受正性肌力药物或利尿剂治疗而无心动过缓或心动过速的患者发生心血管事件的风险较高。无论心率如何，这些药物的使用是HF患者心血管事件的最强临床预测因子。
In previous retrospective studies, we identified the 50 most influential clinical predictors of cardiovascular outcomes in patients with heart failure (HF). The present study aimed to use the novel limitless-arity multiple-testing procedure to filter these 50 clinical factors and thus yield combinations of no more than four factors that could potentially predict the onset of cardiovascular events. A Kaplan–Meier analysis was used to investigate the importance of the combinations. In a multi-centre observational trial, we prospectively enrolled 213 patients with HF who were hospitalized because of exacerbation, discharged according to HF treatment guidelines and observed to monitor cardiovascular events. After the observation period, we stratified patients according to whether they experienced cardiovascular events (rehospitalisation or cardiovascular death). Among 77,562 combinations of fewer than five clinical parameters, we identified 151 combinations that could potentially explain the occurrence of cardiovascular events. Of these, 145 combinations included the use of inotropic agents, whereas the remaining 6 included the use of diuretics without bradycardia or tachycardia, suggesting that the high probability of cardiovascular events is exclusively determined by these two clinical factors. Importantly, Kaplan–Meier curves demonstrated that the use of inotropes or of diuretics without bradycardia or tachycardia were independent predictors of a markedly worse cardiovascular prognosis. Patients treated with either inotropic agents or diuretics without bradycardia or tachycardia were at a higher risk of cardiovascular events. The uses of these drugs, regardless of heart rate, are the strongest clinical predictors of cardiovascular events in patients with HF.
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非线性方程使用血浆脑脂肪酸肽水平来预测心力衰竭患者的心血管结局。
影响因子：
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