Recovered heart failure with reduced ejection fraction and outcomes: a prospective study
Recovered heart failure with reduced ejection fraction and outcomes: a prospective study
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DOI：
10.1002/ejhf.824
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发表时间：
2017-12-01
影响因子：
18.2
通讯作者：
Bayes-Genis, Antoni
中科院分区：
文献类型：
--
作者：
Lupon, Josep;Diez-Lopez, Carles;Bayes-Genis, Antoni
目的：在部分心力衰竭（HF）和射血分数降低（HFrEF）患者中，左心室射血分数（LVEF）显著恢复。我们分析了结局，包括死亡率[全因死亡、心血管（CV）死亡、HF相关死亡和猝死]，以及HF恢复组的HF相关住院。主要终点是CV死亡或HF住院治疗的复合物。方法和结果LVEF在基线和1年在1057个连续的HF患者进行了评估。患者分为三组：（i）HF恢复：< 45% at baseline and >1年时LVEF = 45%（n = 233）;（ii）HF保留EF（HFpEF）：整个随访期间LVEF = 45%（n = 117）;（iii）HFrEF：整个随访期间LVEF < 45%（n = 707）。平均随访时间为5.6 ± 3.1年。HF恢复患者在人口统计学和临床特征方面与HFrEF和HFpEF组不同。HF恢复患者的平均LVEF增加为21.1 ± 10分。使用HF恢复组作为参考，HFpEF和HFrEF组的主要复合终点（n = 376）的风险（非CV死亡作为竞争风险）为：危险比（HR）2.33 [95% CI 1.60-3.39]，P < 0.001; HR 1.99（95% CI 1.50-2.65），P < 0.001。与HFrEF相比，HF恢复受试者的全因（n = 429）、CV（n = 245）、HF相关（n = 127）和猝死（n = 60）显著降低（均P < 0.01）。HF恢复组HF复发住院率明显低于对照组（P < 0.001）。相对于HFpEF和HFrEF受试者，HF恢复患者的死亡率和发病率显著改善。需要进一步的研究来确定HF康复患者的最佳药物和器械适应症。
Aims Significant recovery of left ventricular ejection fraction (LVEF) occurs in a proportion of patients with heart failure (HF) and reduced ejection fraction (HFrEF). We analysed outcomes, including mortality [all-cause, cardiovascular (CV), HF-related, and sudden death], and HF-related hospitalizations in this HF-recovered group. The primary endpoint was a composite of CV death or HF hospitalization.Methods and results LVEF was assessed at baseline and at 1 year in 1057 consecutive HF patients. Patients were classified into three groups: (i) HF-recovered: LVEF < 45% at baseline and >= 45% at 1 year (n = 233); (ii) HF with preserved EF (HFpEF): LVEF = 45% throughout follow-up (n = 117); and (iii) HFrEF: LVEF < 45% throughout follow-up (n = 707). Mean follow-up was 5.6 +/- 3.1 years. HF-recovered patients differed from HFrEF and HFpEF groups in demographic and clinical characteristics. The mean LVEF increase was 21.1 +/- 10 points in HF-recovered patients. Using the HF-recovered group as a reference, the risks for the primary composite endpoint (n = 376), with non-CV death as competing risk, for HFpEF and HFrEF groups were: hazard ratio (HR) 2.33 [95% confidence interval (CI) 1.60-3.39], P < 0.001 and HR 1.99 (95% CI 1.50-2.65), P < 0.001, respectively. All-cause (n = 429), CV (n = 245), HF-related (n = 127), and sudden death (n = 60) were significantly lower in HF-recovered subjects relative to HFrEF (all P < 0.01). HF-recovered patients also experienced less recurrent HF hospitalizations (P < 0.001).Conclusion One in four treated patients with HFrEF showed recovery of systolic function. HF-recovered patients had significantly improved mortality and morbidity relative to HFpEF and HFrEF subjects. Further research is needed to identify optimal medications and device indications for HF-recovered patients.