Congestive heart failure in old age: Prevalence, mechanisms and 4-year prognosis in the Helsinki Ageing Study
Congestive heart failure in old age: Prevalence, mechanisms and 4-year prognosis in the Helsinki Ageing Study
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DOI：
10.1046/j.1365-2796.1997.129150000.x
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发表时间：
1997-05-01
影响因子：
11.1
通讯作者：
Tilvis, R
中科院分区：
文献类型：
--
作者：
Kupari, M;Lindroos, M;Tilvis, R
目标。探讨老年充血性心力衰竭（CHF）的患病率、基础疾病、左心室功能异常及预后。一项基于人群的临床和超声心动图研究，随访4年死亡率。大学医院。研究对象：1901年、1909年和1914年出生的501人（367名女性）。主要结果测量。根据临床和胸片标准存在CHF；超声心动图观察左室大小和收缩功能；多普勒超声心动图评价主动脉瓣和二尖瓣病变等级；4年总死亡率和心血管死亡率。501名参与者中有41名（8.2%）患有CHF。缺血性心脏病（54%）、高血压（54%）和中重度二尖瓣或主动脉瓣疾病（51%）是主要的潜在疾病；90%的患者患有以上一种或多种疾病。大多数CHF患者（39例患者中的28例，72%）超声心动图显示左心室收缩正常。“舒张性CHF”，定义为左心室收缩功能正常且无反流性瓣膜疾病的CHF，占51%（39例患者中的20例）。经年龄和性别调整后，与CHF相关的4年相对死亡风险，全因死亡率为2.1(95%可信区间1.3-3.4)，心血管死亡率为4.2 （CI 1.9-5.6）。在75-86岁人群中，瑞士法郎的患病率约为8%。缺血性或瓣膜性心脏病和高血压是主要的潜在疾病。超声心动图显示，约50%的老年CHF患者在无瓣膜疾病的情况下左心室收缩正常，另有20%的患者伴有二尖瓣反流，收缩功能正常。在4年随访期间，CHF的存在使所有原因导致的经年龄和性别调整的死亡风险增加一倍，心血管死亡风险增加四倍。
Objective. To examine the prevalence, underlying diseases, abnormalities of left ventricular function and prognosis in congestive heart failure (CHF) of old age.Design. A population-based clinical and echocardiographic study with a 4-year mortality followup.Setting. University hospital.Subjects, Five hundred and one individuals born in 1904, 1909 and 1914 (367 women).Main outcome measures. Presence of CHF by clinical and chest radiograph criteria; left ventricular size and systolic function by echocardiography; grade of aortic and mitral valve lesions by Doppler echocardiography; 4-year total and cardiovascular mortality.Results. Forty-one of 501 participants (8.2%) had CHF. Ischaemic heart disease (54%), hypertension (54%) and moderate-to-severe mitral or aortic valve disease (51%) were the main underlying conditions; 90% of patients had one or more of these diseases. Most individuals with CHF (28 of 39 patients, 72%) had normal left ventricular contractions at echocardiography. 'Diastolic CHF', defined as CHF with normal systolic left ventricular function and no regurgitant valve disease, was found in 51% (20 of 39 patients). The relative 4-year risk for death associated with CHF, adjusted for age and sex, was 2.1 (95% confidence interval 1.3-3.4) for all-cause mortality and 4.2 (CI 1.9-5.6) for cardiovascular mortality.Conclusions. The prevalence of CHF in a population aged 75-86 years is approximately 8%. Ischaemic or valvular heart disease and hypertension are the main underlying conditions. At echocardiography, about 50% of the elderly with CHF have normal left ventricular systolic contractions in the absence of valve disease and an additional 20% have normal systolic function with mitral regurgitation. The presence of CHF doubles the age- and sex-adjusted risk of death from all causes, and quadruples the risk of cardiovascular death during 4-year follow-up.