Risk of de-novo heart failure and competing risk in asymptomatic patients with structural heart diseases.
Risk of de-novo heart failure and competing risk in asymptomatic patients with structural heart diseases.
复制标题
无症状结构性心脏病患者的新发心力衰竭风险和竞争风险。
DOI：
10.1016/j.ijcard.2020.02.015
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发表时间：
2020
期刊：
影响因子：
3.5
通讯作者：
Shimokawa H; CHART-2 Investigators..
中科院分区：
文献类型：
--
作者：
Takada T;Sakata Y;Nochioka K;Miura M;Abe R;Kasahara S;Sato M;Aoyanagi H;Fujihashi T;Yamanaka S;Suzuki K;Shiroto T;Sugimura K;Takahashi J;Miyata S;Shimokawa H; CHART-2 Investigators..
目的无症状的结构性心脏病患者被归类为B期心力衰竭（HF）高危人群。然而，考虑到这一人群中的竞争风险，关于新发HF（DNHF）的发病率和相关因素的数据有限。（平均年龄68岁，男性76%）来自CHART-2研究（N = 10，219），我们检查了死亡和DNHF的发生率，DNHF定义为HF住院或HF死亡的首次发作，结果在平均6.0年的随访中，627例死亡（31/1000人年）和293例DNHF（15/1000人年）发生。在627例死亡中，分别有212例（34%）和325例（52%）为心血管和非心血管死亡。在271例DNHF住院患者的随访期间，我们观察到124例死亡，包括65例（52%）心血管死亡和47例（40%）非心血管死亡。竞争风险模型显示年龄、糖尿病、卒中、房颤、舒张压、血红蛋白水平、估计肾小球滤过率和左心室射血分数与DNHF显著相关。贝叶斯结构方程模型表明，许多这些心脏和非心脏变量有助于DNHF相互影响，而糖尿病是独立与DNHF.ConclusionsStage B患者有很高的发病率DNHF以及由于心血管和非心血管原因的死亡。因此，B期患者的管理应包括考虑心脏和非心脏因素的多学科方法，以防止DNHF以及非HF死亡作为竞争风险。clinicaltrials.gov
AimsAsymptomatic patients with structural heart diseases are classified as a population at high risk for heart failure (HF) in Stage B. However, limited data are available regarding incidence and related factors of de-novo HF (DNHF) considering competing risk in this population.Methods and resultsIn 3362 Stage B patients (mean age 68 yrs, male 76%) from the CHART-2 Study (N = 10,219), we examined incidence of death and DNHF, defined as the first episode of either HF hospitalization or HF death, and factors related to DNHF.ResultsDuring the median 6.0-year follow-up, 627 deaths (31/1000 person-years) and 293 DNHF (15/1000 person-years) occurred. Among the 627 deaths, 212 (34%) and 325 (52%) were specified as cardiovascular and non-cardiovascular deaths, respectively. During the follow-up of 271 DNHF hospitalizations, we observed 124 deaths, including 65 (52%) cardiovascular and 47 (40%) non-cardiovascular deaths. The competing risk model showed that age, diabetes mellitus, stroke, atrial fibrillation, diastolic blood pressure, hemoglobin levels, estimated glomerular filtration ratio and left ventricular ejection fraction was significantly associated with DNHF. Bayesian structural equation modeling showed that many of these cardiac and non-cardiac variables contribute to DNHF by affecting each other, while diabetes mellitus was independently associated with DNHF.ConclusionsStage B patients had a high incidence of DNHF as well as that of death due to both cardiovascular and non-cardiovascular causes. Thus, management of Stage B patients should include multidisciplinary approaches considering both cardiac and non-cardiac factors, in order to prevent DNHF as well as non-HF death as a competing risk.Trial registration: clinicaltrials.gov identifier: NCT00418041.