Cardiovascular phenotype in HFpEF patients with or without diabetes: a RELAX trial ancillary study.
Cardiovascular phenotype in HFpEF patients with or without diabetes: a RELAX trial ancillary study.
复制标题
DOI：
10.1016/j.jacc.2014.05.030
复制
发表时间：
2014-08-12
影响因子：
24
通讯作者：
Redfield, Margaret M.
中科院分区：
文献类型：
--
作者：
Lindman, Brian R.;Davila-Roman, Victor G.;Mann, Douglas L.;McNulty, Steven;Semigran, Marc J.;Lewis, Gregory D.;de las Fuentes, Lisa;Joseph, Susan M.;Vader, Justin;Hernandez, Adrian F.;Redfield, Margaret M.
关键词：
RELAX 是一项西地那非与安慰剂治疗心力衰竭和射血分数保留 (HFpEF) 的多中心随机试验，具有严格的入选标准和广泛的参与者表型特征。描述患有或不患有糖尿病的 HFpEF 患者的临床特征、运动能力和结果，并深入了解病理生理机制。 RELAX 纳入了 216 名患有心力衰竭、EF ≥ 50%、钠尿肽或心内压升高以及运动能力降低的稳定门诊患者。前瞻性收集的数据包括超声心动图、心脏磁共振成像、综合生物标志物组、运动测试和 6 个月以上的临床事件。与非糖尿病患者 (n=123) 相比，糖尿病患者 (n=93) HFpEF 患者更年轻、更肥胖、男性更常见，并且高血压、肾功能不全、肺部疾病和血管疾病的患病率更高（全部 p<0.05）。糖尿病患者的尿酸、C 反应蛋白、半乳糖凝集素 3、I 型胶原羧基末端端肽和内皮素 1 水平较高（全部 p<0.05）。糖尿病患者心室肥厚程度更高，但糖尿病患者和非糖尿病患者的收缩期和舒张期心室功能参数相似，除了糖尿病患者充盈压 (E/e') 较高的趋势外。糖尿病患者的最大（峰值摄氧量）和次最大（6 分钟步行距离）运动能力较差（两者均 p<0.01）。糖尿病患者在进入研究前一年更有可能因心力衰竭住院（47% vs 28%，p=0.004），并且在入组后 6 个月时因心脏或肾脏住院的发生率较高（23.7% vs 4.9%，p<0.001）。患有糖尿病的 HFpEF 患者住院的风险增加，并且运动能力下降。多种发病率、变时性储备受损、左心室肥大以及炎症、促氧化、血管收缩和促纤维化途径的激活可能会导致糖尿病 HFpEF 患者的不良后果。 (NCT00763867)
RELAX was a multicenter randomized trial of sildenafil versus placebo in heart failure and preserved ejection fraction (HFpEF) with rigorous entry criteria and extensive phenotypic characterization of participants. To characterize clinical features, exercise capacity, and outcomes in patients with HFpEF with or without diabetes and gain insight into contributing pathophysiologic mechanisms. RELAX enrolled 216 stable outpatients with heart failure, EF ≥50%, elevated natriuretic peptide or intracardiac pressures, and reduced exercise capacity. Prospectively collected data included echocardiography, cardiac magnetic resonance imaging, a comprehensive biomarker panel, exercise testing, and clinical events over 6 months. Compared with non-diabetics (n=123), diabetic (n=93) HFpEF patients were younger, more obese, more often male, and had a higher prevalence of hypertension, renal dysfunction, pulmonary disease, and vascular disease (p<0.05 for all). Uric acid, C-reactive protein, galectin-3, carboxy-terminal telopeptide of collagen type I, and endothelin-1 levels were higher in diabetics (p<0.05 for all). Diabetic patients had more ventricular hypertrophy but systolic and diastolic ventricular function parameters were similar in diabetics and non-diabetics except for a trend toward higher filling pressures (E/e′) in diabetics. Diabetics had worse maximal (peak oxygen uptake) and submaximal (6-minute walk distance) exercise capacity (p<0.01 for both). Diabetic patients were more likely to have been hospitalized for HF in the year prior to study entry (47% vs 28%, p=0.004) and had a higher incidence of cardiac or renal hospitalization at 6 months after enrollment (23.7% vs 4.9%, p<0.001). HFpEF patients with diabetes are at increased risk of hospitalization and have reduced exercise capacity. Multi-morbidity, impaired chronotropic reserve, left ventricular hypertrophy and activation of inflammatory, pro-oxidative, vasoconstrictor, and pro-fibrotic pathways may contribute to adverse outcomes in HFpEF patients with diabetes. (NCT00763867)
登录
查看更多内容
影响因子：
2.8
作者：
Khan, MN;Pothier, CE;Lauer, MS
通讯作者：
Lauer, MS
DOI：
10.1161/circheartfailure.110.958785
发表时间：
2010-11
期刊：
Circulation. Heart failure
影响因子：
--
作者：
Kitzman DW;Brubaker PH;Morgan TM;Stewart KP;Little WC
通讯作者：
Little WC
影响因子：
24
作者：
Haykowsky, Mark J.;Brubaker, Peter H.;Stewart, Kathryn P.;Morgan, Timothy M.;Eggebeen, Joel;Kitzman, Dalane W.
通讯作者：
Kitzman, Dalane W.
DOI：
10.1161/circheartfailure.114.001192
发表时间：
2014-07
期刊：
Circulation. Heart failure
影响因子：
--
作者：
Mohammed SF;Borlaug BA;McNulty S;Lewis GD;Lin G;Zakeri R;Semigran MJ;LeWinter M;Hernandez AF;Braunwald E;Redfield MM
通讯作者：
Redfield MM
影响因子：
16.2
作者：
Park, Seok Won;Goodpaster, Bret H.;Newman, Anne B.
通讯作者：
Newman, Anne B.