Changing Characteristics and Mode of Death Associated With Chronic Heart Failure Caused by Left Ventricular Systolic Dysfunction A Study Across Therapeutic Eras
Changing Characteristics and Mode of Death Associated With Chronic Heart Failure Caused by Left Ventricular Systolic Dysfunction A Study Across Therapeutic Eras
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DOI：
10.1161/circheartfailure.110.959882
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发表时间：
2011-07-01
影响因子：
9.7
通讯作者：
Kearney, Mark T.
中科院分区：
文献类型：
--
作者：
Cubbon, Richard M.;Gale, Christopher P.;Kearney, Mark T.
背景-近几十年来，左心室收缩功能障碍引起的慢性心力衰竭患者的治疗方法有了很大的进步。这些疗法对死亡率、死亡方式、症状和临床特征的累积效应尚未明确。方法和结果--本研究比较了1993年至1995年期间进行的2项前瞻性队列研究，这些研究对象为左心室收缩功能障碍所致的慢性心力衰竭门诊患者（历史队列：n = 281）和2006年和2009年（当代队列：n = 357）。在历史队列中，83%的患者使用血管紧张素转换酶抑制剂，8.5%的患者使用β-肾上腺素受体拮抗剂，而在同期队列中，这一比例分别为89%和80%。随访第一年的死亡率从12.5%下降到7.8%（P = 0.04），猝死对同期死亡率的贡献较小（33.6%对12.7%; P < 0.001）。纽约心脏协会分级在两个时期之间下降（P < 0.001）。胸导联的QTc离散度从85 ms（SD，2）降至34 ms（SD，1），左心室舒张末期内径从65 mm（SD，2）降至34 mm（SD，1）。（SD，0.6）至59 mm（标准差，0.5）结论：在过去的15年中，左心室收缩功能不全引起的慢性心力衰竭患者的生存率显著提高;此外，猝死对死亡率的贡献要小得多，非心源性死亡率的贡献相应较大。这伴随着症状的改善和一些不良电和结构性左心室重塑的标志物。(Circ心脏衰竭。2011; 4：396-403.）
Background-Therapies for patients with chronic heart failure caused by left ventricular systolic dysfunction have advanced substantially over recent decades. The cumulative effect of these therapies on mortality, mode of death, symptoms, and clinical characteristics has yet to be defined.Methods and Results-This study was a comparison of 2 prospective cohort studies of outpatients with chronic heart failure caused by left ventricular systolic dysfunction performed between 1993 and 1995 (historic cohort: n = 281) and 2006 and 2009 (contemporary cohort: n = 357). In the historic cohort, 83% were prescribed angiotensin-converting enzyme inhibitors and 8.5% were prescribed beta-adrenoceptor antagonists, compared with 89% and 80%, respectively, in the contemporary cohort. Mortality rates over the first year of follow-up declined from 12.5% to 7.8% between eras (P = 0.04), and sudden death contributed less to contemporary mortality (33.6% versus 12.7%; P < 0.001). New York Heart Association class declined between eras (P < 0.001). QTc dispersion across the chest leads declined from 85 ms (SD, 2) to 34 ms (SD, 1) and left ventricular end-diastolic dimensions declined from 65 mm (SD, 0.6) to 59 mm (SD, 0.5) (both P < 0.001).Conclusions-Survival has significantly improved in patients with chronic heart failure caused by left ventricular systolic dysfunction over the past 15 years; furthermore, sudden death makes a much smaller contribution to mortality, and noncardiac mortality is a correspondingly greater contribution. This has been accompanied by an improvement in symptoms and some markers of adverse electric and structural left ventricular remodeling. (Circ Heart Fail. 2011; 4: 396-403.)