Longitudinal changes in ejection fraction in heart failure patients with preserved and reduced ejection fraction.
Longitudinal changes in ejection fraction in heart failure patients with preserved and reduced ejection fraction.
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DOI：
10.1161/circheartfailure.111.966366
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发表时间：
2012-11
期刊：
影响因子：
--
通讯作者：
Redfield MM
中科院分区：
文献类型：
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作者：
Dunlay SM;Roger VL;Weston SA;Jiang R;Redfield MM
心力衰竭（HF）可发生在保持（HFpEF, EF 50%）或降低（HFrEF， EF<50%）射血分数（EF）的患者中，但HF诊断后EF的变化尚未得到很好的描述。在明尼苏达州奥姆斯特德县1984-2009年诊断的突发心衰患者的社区队列中，我们获得了从最初的心衰诊断到死亡或最后一次随访到2010年3月的所有超声心动图评估。混合效应模型拟合一个独特的线性回归线，每个人使用串行EF数据。编译后的结果可以估计HFpEF和HFrEF随时间的变化。1233例HF患者（男性48.3%，平均年龄75.0岁，平均随访5.1年）中，559例（45.3%）在诊断时有HFpEF。在HFpEF中，EF在5年内平均下降5.8% (p<0.001)，老年人和冠心病患者下降更大。相反，EF增加了HFrEF（5年平均增加6.9%,p<0.001）。在女性、年轻患者、无冠状动脉疾病的个体和接受循证药物治疗的患者中，发病率增加幅度更大。总体而言，39%的HFpEF患者在诊断后某个时间点的EF<50%， 39%的HFrEF患者的EF≥50%。随着时间的推移，EF的减少与生存期的减少有关，而EF的增加与生存期的改善有关。这些数据表明进行性收缩功能障碍可能与HFpEF的病理生理有关。需要前瞻性纵向研究来证实这些观察结果，并确定HFpEF患者EF随时间下降的机制和临床相关性。
Heart failure (HF) can occur in patients with preserved (HFpEF, EF 50%) or reduced (HFrEF, EF<50%) ejection fraction (EF), but changes in EF after HF diagnosis are not well described. Among a community cohort of incident HF patients diagnosed from 1984–2009 in Olmsted County, Minnesota, we obtained all EFs assessed by echocardiography from initial HF diagnosis until death or last follow-up through March 2010. Mixed effects models fit a unique linear regression line for each person using serial EF data. Compiled results allowed estimates of the change in EF over time in HFpEF and HFrEF. Among 1233 HF patients (48.3% male, mean age 75.0 years, mean follow-up 5.1 years), 559 (45.3%) had HFpEF at diagnosis. In HFpEF, on average, EF decreased by 5.8% over 5 years (p<0.001) with greater declines in older individuals and those with coronary disease. Conversely, EF increased in HFrEF (average increase 6.9% over 5 years, p<0.001). Greater increases were noted in women, younger patients, individuals without coronary disease, and those treated with evidence-based medications. Overall, 39% of HFpEF patients had an EF<50% and 39% of HFrEF patients had an EF≥50% at some point after diagnosis. Decreases in EF over time were associated with reduced survival while increases in EF were associated with improved survival. These data suggest that progressive contractile dysfunction may contribute to the pathophysiology of HFpEF. Prospective longitudinal studies are needed to confirm these observations and establish the mechanism and clinical relevance of decline in EF over time in HFpEF.