Effect of digoxin in patients with heart failure and mid-range (borderline) left ventricular ejection fraction
Effect of digoxin in patients with heart failure and mid-range (borderline) left ventricular ejection fraction
复制标题
DOI：
10.1002/ejhf.1160
复制
发表时间：
2018-07-01
影响因子：
18.2
通讯作者：
McMurray, John J. V.
中科院分区：
文献类型：
--
作者：
Abdul-Rahim, Azmil H.;Shen, Li;McMurray, John J. V.
目的评价地高辛对新描述的由轻度左心室收缩功能障碍引起的心力衰竭（HF）和中程射血分数（HFmrEF）患者的影响。方法和结果我们对Digitalis研究组（DIG）试验进行了回顾性分析，该试验有7788例左室射血分数（LVEF）在3%至85%之间的患者可供分析。我们比较了地高辛与安慰剂在三组相互排斥的LVEF类别患者中的作用：= 50% （HF with preserved LVEF, HFpEF, n=719）。主要结局是心血管死亡或心衰住院的综合结果。HFmrEF患者在年龄、性别和病因方面与HFrEF患者比HFpEF患者更相似，但在血压和高血压患病率方面与HFpEF患者更相似。HFmrEF患者的事件发生率与HFpEF患者相似，远低于HFrEF患者。地高辛降低了HFrEF患者的主要终点，主要是由于降低了HF住院率：地高辛/安慰剂的HF住院风险比（HR）为0.71[95%可信区间（CI） 0.65-0.77]。HFmrEF患者HF住院的地高辛/安慰剂HR为0.80 (95% CI 0.63-1.03)， HFpEF患者住院的地高辛/安慰剂HR为0.85 （95% CI 0.62-1.17）。地高辛/安慰剂对HF死亡或HF住院的综合风险比在HFrEF组为0.74 (95% CI 0.68-0.81)， HFmrEF组为0.83 (95% CI 0.66-1.05)， HFpEF组为0.88 （95% CI 0.65-1.19）。结论在本研究中，HFmrEF患者的事件发生率更接近于HFpEF患者，而不是HFrEF患者。地高辛对HFrEF患者HF住院的影响最大，对HFmrEF的影响中等，对HFpEF的影响最小。
Aims To evaluate the effects of digoxin in patients with the newly described phenotype of heart failure (HF) and mid-range ejection fraction (HFmrEF), attributed to mild left ventricular systolic dysfunction.Methods and results We carried out a retrospective analysis of the Digitalis Investigation Group (DIG) trial which had 7788 patients available for analysis with a left ventricular ejection fraction (LVEF) ranging between 3% and 85%. We compared the effect of digoxin to placebo in three mutually exclusive groups of patients defined by LVEF category: = 50% (HF with preserved LVEF, HFpEF, n=719). The primary outcome was the composite of cardiovascular death or HF hospitalisation. Patients with HFmrEF resembled patients with HFrEF, more than those with HFpEF, with respect to age, sex and aetiology but were more like HFpEF patients with respect to blood pressure and the prevalence of hypertension. Event rates in patients with HFmrEF were similar to those in HFpEF and much lower than in HFrEF. Digoxin reduced the primary endpoint in patients with HFrEF, mainly due to reduced HF hospitalisation: the digoxin/placebo hazard ratio (HR) for HF hospitalisation was 0.71 [95% confidence interval (CI) 0.65-0.77]. The digoxin/placebo HR for HF hospitalisation in patients with HFmrEF was 0.80 (95% CI 0.63-1.03) and 0.85 (95% CI 0.62-1.17) in those with HFpEF. The digoxin/placebo HR for the composite of HF death or HF hospitalisation was 0.74 (95% CI 0.68-0.81) in HFrEF, 0.83 (95% CI 0.66-1.05) in HFmrEF and 0.88 (95% CI 0.65-1.19) in HFpEF.Conclusions In this study, event rates in patients with HFmrEF were closer to those in HFpEF than HFrEF. Digoxin had most effect on HF hospitalisation in patients with HFrEF, an intermediate effect in HFmrEF, and the smallest effect in HFpEF.