Natural history of left ventricular ejection fraction in patients with heart failure.
Natural history of left ventricular ejection fraction in patients with heart failure.
复制标题
心力衰竭患者左心室射血分数的自然病史。
DOI：
10.1161/circoutcomes.111.000045
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发表时间：
2013-11
期刊：
影响因子：
--
通讯作者：
Masoudi FA
中科院分区：
文献类型：
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作者：
Clarke CL;Grunwald GK;Allen LA;Barón AE;Peterson PN;Brand DW;Magid DJ;Masoudi FA
由于左心室射血分数（LVEF）对治疗决策和预后的重要性，心力衰竭（HF）患者通常被指定为射血分数降低或保留（HFREF，HFPEF）。这些名称不一定是静态的，但很少有数据描述LVEF随时间的自然变化。我们确定了2413例来自Kaiser Permanente科罗拉多的患者，他们在2001年1月1日至2008年12月31日期间出院时的主要诊断为HF，且有≥2次LVEF测量，间隔≥30天。我们使用多状态马尔可夫模型来研究HFREF，HFPEF和死亡之间的转换。我们总共观察到8183次跃迁。女性比男性更有可能从HFREF过渡到HFPEF（风险比，1.85; 95%置信区间，1.38-2.47）。与不依从β受体阻滞剂的患者相比，依从β受体阻滞剂的患者更可能从HFREF转换为HFPEF（风险比，1.53; 95%置信区间，1.10-2.13），而血管紧张素转换酶或血管紧张素II受体阻滞剂依从性与LVEF转换无关。既往有心肌梗死史的患者更有可能从HFPEF转换为HFREF（风险比，1.75; 95%置信区间，1.26-2.42）。在该HF患者队列中，LVEF是与性别、共存疾病和药物治疗相关的动态因素。这些发现对心力衰竭患者左心室收缩功能的确定有意义，并支持循证治疗的使用，特别是β受体阻滞剂。
Patients with heart failure (HF) are typically designated as having reduced or preserved ejection fraction (HFREF, HFPEF) because of the importance of left ventricular ejection fraction (LVEF) on therapeutic decisions and prognosis. Such designations are not necessarily static, yet few data exist to describe the natural history of LVEF over time. We identified 2413 patients from Kaiser Permanente Colorado with a primary discharge diagnosis of HF between January 1, 2001, and December 31, 2008, who had ≥2 LVEF measurements separated by ≥30 days. We used multi-state Markov modeling to examine transitions among HFREF, HFPEF, and death. We observed a total of 8183 transitions. Women were more likely than men to transition from HFREF to HFPEF (hazard ratio, 1.85; 95% confidence interval, 1.38–2.47). Patients who were adherent to β-blockers were more likely to transition from HFREF to HFPEF (hazard ratio, 1.53; 95% confidence interval, 1.10–2.13) compared with patients who were nonadherent to β-blockers, whereas angiotensin-converting enzyme or angiotensin II receptor blocker adherence was not associated with LVEF transitions. Patients who had a previous myocardial infarction were more likely to transition from HFPEF to HFREF (hazard ratio, 1.75; 95% confidence interval, 1.26–2.42). In this cohort of patients with HF, LVEF is a dynamic factor related to sex, coexisting conditions, and drug therapy. These findings have implications for left ventricular systolic function ascertainment in patients with HF and support evidence-based therapy use, especially β-blockers.