Functional Status, Pulmonary Artery Pressure, and Clinical Outcomes in Heart Failure With Preserved Ejection Fraction
Functional Status, Pulmonary Artery Pressure, and Clinical Outcomes in Heart Failure With Preserved Ejection Fraction
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DOI：
10.1016/j.jacc.2016.04.052
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发表时间：
2016-07-12
影响因子：
24
通讯作者：
Bonderman, Diana
中科院分区：
文献类型：
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作者：
Dalos, Daniel;Mascherbauer, Julia;Bonderman, Diana
射血分数正常的心力衰竭患者存在功能障碍，导致生活质量下降。本研究的目的是确定与纽约心脏协会（NYHA）功能分级相关的血液动力学和其他患者相关变量，并结合其他临床、实验室、成像、和血流动力学参数对结果的影响。方法2011年1月至2015年2月，入选193例射血分数正常的心力衰竭患者。与症状较轻的患者（NYHA II级; n = 57）相比，III级和IV级患者（n = 136）年龄较大（p = 0.008），体重指数较高（p = 0.004），N末端脑钠肽前体水平较高（p = 0.001）。此外，反映左心室舒张功能障碍的参数在高级NYHA分级中更明显（早期二尖瓣流入速度/舒张早期二尖瓣环速度; p = 0.023），反映右心室后负荷的参数（舒张期肺动脉压; p < 0.001）。通过多变量回归分析，年龄（p = 0.007）、体重指数（p = 0.002）、N-末端脑钠肽前体（p < 0.001）、早期二尖瓣血流速度/晚期充盈二尖瓣峰值速度（p = 0.031）和舒张期肺动脉压（p < 0.001）与高级NYHA分级独立相关。随访21.9个月后，64例患者（33.2%）达到了联合终点，定义为因心力衰竭和/或心源性死亡住院。通过多变量考克斯分析，NYHA心功能分级与预后独立相关（风险比：2.133; p = 0.040），以及N-末端脑钠肽前体（风险比：1.655; p < 0.001）和右心室功能受损（风险比：2.360;结论射血分数正常的心力衰竭患者的呼吸困难症状是多因素的，主要与体重指数，左室舒张功能，和肺血管有临床意义的治疗干预应针对体重、左心室僵硬度和伴随的肺血管疾病。(C)2016年由美国心脏病学会基金会。
BACKGROUND Patients with heart failure with preserved ejection fraction have functional impairment resulting in reduced quality of life. Specific pathological mechanisms underlying symptoms have not yet been defined.OBJECTIVES The aim of this study was to identify hemodynamic and other patient-related variables that are associated with New York Heart Association (NYHA) functional class and to analyze functional class in perspective with other clinical, laboratory, imaging, and hemodynamic parameters with respect to its influence on outcomes.METHODS Between January 2011 and February 2015, 193 patients with confirmed heart failure with preserved ejection fraction were enrolled.RESULTS Those in more advanced NYHA functional classes (III and IV; n = 136) were older (p = 0.008), had higher body mass indexes (p = 0.004), and had higher levels of N-terminal pro-brain natriuretic peptide (p = 0.001) compared with less symptomatic patients (NYHA class II; n = 57). Furthermore, parameters reflecting left ventricular diastolic dysfunction were more pronounced in advanced NYHA classes (early mitral inflow velocity/early diastolic mitral annular velocity; p = 0.023) as well as parameters reflecting right ventricular afterload (diastolic pulmonary artery pressure; p < 0.001). By multivariate regression analysis, age (p = 0.007), body mass index (p = 0.002), N-terminal pro-brain natriuretic peptide (p < 0.001), early mitral inflow velocity/mitral peak velocity of late filling (p = 0.031), and diastolic pulmonary artery pressure (p < 0.001) were independently associated with advanced NYHA class. After 21.9 months of follow-up, 64 patients (33.2%) reached the combined endpoint, defined as hospitalization for heart failure and/or cardiac death. By multivariate Cox analysis, NYHA functional class was independently associated with outcome (hazard ratio: 2.133; p = 0.040), as well as N-terminal pro-brain natriuretic peptide (hazard ratio: 1.655; p < 0.001) and impaired right ventricular function (hazard ratio: 2.360; p = 0.001).CONCLUSIONS Symptoms of breathlessness in patients with heart failure with preserved ejection fraction are multifactorial and largely related to body mass index, left ventricular diastolic function, and the pulmonary vasculature. Clinically meaningful therapeutic interventions should target body weight, left ventricular stiffness, and concomitant pulmonary vascular disease. (C) 2016 by the American College of Cardiology Foundation.