Concentric vs. eccentric remodelling in heart failure with reduced ejection fraction: clinical characteristics, pathophysiology and response to treatment.
Concentric vs. eccentric remodelling in heart failure with reduced ejection fraction: clinical characteristics, pathophysiology and response to treatment.
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DOI：
10.1002/ejhf.1632
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发表时间：
2020-07
影响因子：
18.2
通讯作者：
Voors AA
中科院分区：
文献类型：
--
作者：
Nauta JF;Hummel YM;Tromp J;Ouwerkerk W;van der Meer P;Jin X;Lam CSP;Bax JJ;Metra M;Samani NJ;Ponikowski P;Dickstein K;Anker SD;Lang CC;Ng LL;Zannad F;Filippatos GS;van Veldhuisen DJ;van Melle JP;Voors AA
心力衰竭传统上根据左心室射血分数（LVEF）而不是左心室（LV）几何形状进行分类，指南推荐治疗射血分数降低的心力衰竭（HFrEF），但不包括射血分数保留的心力衰竭（HFpEF）。大多数 HFrEF 患者有偏心性左室肥厚，但也有一些患者有向心性左室肥厚。我们的目的是比较 HFrEF 和偏心与向心左心室肥厚患者的临床特征、生物标志物模式和治疗反应。我们对来自跨国观察性 BIOSTAT-CHF 研究的 1015 名 HFrEF (LVEF <40%) 患者进行了回顾性事后分析。使用二维超声心动图对左心室几何形状进行分类。使用 92 种生物标志物的网络分析来研究病理生理学途径。 142 名 (14%) 患者存在向心性左心室肥厚，与偏心性左心室肥厚患者相比，这些患者平均年龄较大，且更有可能患有高血压。网络分析显示，N端B型利钠肽原是偏心肥大的重要枢纽，而向心肥大中，肿瘤坏死因子受体1、尿激酶纤溶酶原激活剂表面受体、对氧磷酶和P-选择素是中心枢纽。 β受体阻滞剂的增量调整与伴有偏心但非同心左心室肥厚的 HFrEF 患者的死亡率获益相关（交互作用 P 值≤0.001）。对于血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂，同心性肥大的死亡率风险比较高，但相互作用并不显着。伴有同心肥厚的 HFrEF 患者的临床和生物标志物表型与偏心肥厚患者明显不同。与离心性肥大的患者相比，向心性肥大的患者可能不会从血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂和β受体阻滞剂的增量滴定中获得类似的益处。
Heart failure is traditionally classified by left ventricular ejection fraction (LVEF), rather than by left ventricular (LV) geometry, with guideline‐recommended therapies in heart failure with reduced ejection fraction (HFrEF) but not heart failure with preserved ejection fraction (HFpEF). Most patients with HFrEF have eccentric LV hypertrophy, but some have concentric LV hypertrophy. We aimed to compare clinical characteristics, biomarker patterns, and response to treatment of patients with HFrEF and eccentric vs. concentric LV hypertrophy. We performed a retrospective post‐hoc analysis including 1015 patients with HFrEF (LVEF <40%) from the multinational observational BIOSTAT‐CHF study. LV geometry was classified using two‐dimensional echocardiography. Network analysis of 92 biomarkers was used to investigate pathophysiologic pathways. Concentric LV hypertrophy was present in 142 (14%) patients, who were on average older and more likely hypertensive compared to those with eccentric LV hypertrophy. Network analysis revealed that N‐terminal pro‐B‐type natriuretic peptide was an important hub in eccentric hypertrophy, whereas in concentric hypertrophy, tumour necrosis factor receptor 1, urokinase plasminogen activator surface receptor, paraoxonase and P‐selectin were central hubs. Up‐titration of beta‐blockers was associated with a mortality benefit in HFrEF with eccentric but not concentric LV hypertrophy (P‐value for interaction ≤0.001). For angiotensin‐converting enzyme inhibitors/angiotensin receptor blockers, the hazard ratio for mortality was higher in concentric hypertrophy, but the interaction was not significant. Patients with HFrEF with concentric hypertrophy have a clinical and biomarker phenotype that is distinctly different from those with eccentric hypertrophy. Patients with concentric hypertrophy may not experience similar benefit from up.‐titration of angiotensin‐converting enzyme inhibitors/angiotensin receptor blockers and beta‐blockers compared to patients with eccentric hypertrophy.
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作者：
Lindsey ML;Iyer RP;Jung M;DeLeon-Pennell KY;Ma Y
通讯作者：
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影响因子：
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