Predictors of new-onset heart failure: differences in preserved versus reduced ejection fraction.
Predictors of new-onset heart failure: differences in preserved versus reduced ejection fraction.
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DOI：
10.1161/circheartfailure.112.972828
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发表时间：
2013-03
期刊：
影响因子：
--
通讯作者：
Levy D
中科院分区：
文献类型：
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作者：
Ho JE;Lyass A;Lee DS;Vasan RS;Kannel WB;Larson MG;Levy D
大约一半的心衰患者保留而不是降低射血分数（HFPEF； HFREF）。导致两种亚型心衰的危险因素的差异尚不清楚。我们试图确定新发HF的临床预测因素，并探讨HFPEF与HFREF的差异。我们研究了1981年至2008年间Framingham心脏研究参与者中新发HF病例，分为HFPEF和HFREF （EF bb0 45% vs≤45%）。我们使用Cox多变量回归来检验8年HF发生风险的预测因子，并使用竞争风险分析来确定HFPEF和HFREF之间的差异预测因子。在6340名参与者（60±12年）中，随访97808人年，512人发生心衰。在诊断HF时进行LVEF评估的457名参与者中，196名（43%）被归类为HFPEF， 261名（56%）被归类为HFREF。确定了总体HF的14个预测因子。年龄较大、糖尿病和瓣膜疾病史预测两种类型的HF （p≤0.0025）。高BMI、吸烟和心房颤动仅预测HFPEF，而男性、高总胆固醇、高心率、高血压、心血管疾病、左室肥厚和左束支传导阻滞预测HFREF的风险。虽然在发生全面HF之前存在多种危险因素，但不同的危险因素决定了新发HFPEF与HFREF的风险。这一知识可能有助于设计针对性预防的临床试验，并引入预防心衰及其两种主要亚型的治疗策略。
About one half of patients with HF have preserved rather than reduced ejection fraction (HFPEF; HFREF). The differences in risk factors predisposing to the two subtypes of HF are poorly understood. We sought to identify clinical predictors of new-onset HF, and to explore differences in HFPEF versus HFREF. We studied new-onset HF cases between 1981 and 2008 in Framingham Heart Study participants, classified into HFPEF and HFREF (EF > 45% vs ≤ 45%). We used Cox multivariable regression to examine predictors of 8-year risk of incident HF, and competing-risks analysis to identify predictors that differed between HFPEF and HFREF. Among 6,340 participants (60 ± 12 years) with 97,808 person-years of follow up, 512 developed incident HF. Of 457 participants with LVEF evaluation at the time of HF diagnosis, 196 (43%) were classified as HFPEF and 261 (56%) as HFREF. Fourteen predictors of overall HF were identified. Older age, diabetes mellitus, and a history of valvular disease predicted both types of HF (p ≤ 0.0025 for all). Higher BMI, smoking, and atrial fibrillation predicted HFPEF only, whereas male sex, higher total cholesterol, higher heart rate, hypertension, cardiovascular disease, left ventricular hypertrophy, and left bundle branch block predicted risk of HFREF. While multiple risk factors preceded overall HF, distinct clusters of risk factors determine risk for new-onset HFPEF versus HFREF. This knowledge may enable the design of clinical trials of targeted prevention and the introduction of therapeutic strategies for prevention of HF and its two major subtypes.