Epidemiology and one-year outcomes in patients with chronic heart failure and preserved, mid-range and reduced ejection fraction: an analysis of the ESC Heart Failure Long-Term Registry
Epidemiology and one-year outcomes in patients with chronic heart failure and preserved, mid-range and reduced ejection fraction: an analysis of the ESC Heart Failure Long-Term Registry
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DOI：
10.1002/ejhf.813
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发表时间：
2017-12-01
影响因子：
18.2
通讯作者：
Filippatos, Gerasimos
中科院分区：
文献类型：
--
作者：
Chioncel, Ovidiu;Lainscak, Mitja;Filippatos, Gerasimos
目的 本研究的目的是描述按左心室射血分数（LVEF）分层的门诊心力衰竭（HF）患者的流行病学特征和预后，并确定每组中1年死亡率的预测因素。
方法与结果 欧洲心脏病学会心力衰竭长期登记研究是一项前瞻性观察性研究，收集了9134例HF患者的流行病学信息和1年随访数据。根据基线LVEF将患者分为射血分数降低的HF[EF < 40%（HFrEF）]、中间范围射血分数的HF[EF 40 - 50%（HFmrEF）]和射血分数保留的HF[EF > 50%（HFpEF）]。与HFpEF患者相比，HFrEF患者更年轻（64岁对69岁），男性更常见（78%对52%），更可能有缺血性病因（49%对24%）和左束支传导阻滞（24%对9%），但患高血压（56%对67%）或心房颤动（18%对32%）的可能性较小。HFmrEF组在一些特征上与HFrEF组相似，包括年龄、性别和缺血性病因，但左心室和心房扩张程度较轻。HFrEF和HFpEF患者1年死亡率差异显著（8.8%对6.3%）；HFmrEF患者的死亡率处于中间水平（7.6%）。年龄、纽约心脏协会（NYHA）III/IV级状态和慢性肾脏病是所有LVEF组死亡率的预测因素。低收缩压和高心率是HFrEF和HFmrEF患者死亡率的预测因素。较低的体重指数与HFrEF和HFpEF患者的死亡率独立相关。心房颤动是HFpEF患者死亡率的预测因素。
结论 按不同LVEF类别分层的心力衰竭患者在人口统计学、临床表现、病因和1年预后方面呈现不同的表型。死亡率预测因素的差异可能会改善风险分层和管理目标。
Aims The objectives of the present study were to describe epidemiology and outcomes in ambulatory heart failure (HF) patients stratified by left ventricular ejection fraction (LVEF) and to identify predictors for mortality at 1 year in each group.Methods and results The European Society of Cardiology Heart Failure Long-Term Registry is a prospective, observational study collecting epidemiological information and 1-year follow-up data in 9134 HF patients. Patients were classified according to baseline LVEF into HF with reduced EF [EF < 40% (HFrEF)], mid-range EF [EF 40-50% (HFmrEF)] and preserved EF [EF > 50% (HFpEF)]. In comparison with HFpEF subjects, patients with HFrEF were younger (64 years vs. 69 years), more commonly male (78% vs. 52%), more likely to have an ischaemic aetiology (49% vs. 24%) and left bundle branch block (24% vs. 9%), but less likely to have hypertension (56% vs. 67%) or atrial fibrillation (18% vs. 32%). The HFmrEF group resembled the HFrEF group in some features, including age, gender and ischaemic aetiology, but had less left ventricular and atrial dilation. Mortality at 1 year differed significantly between HFrEF and HFpEF (8.8% vs. 6.3%); HFmrEF patients experienced intermediate rates (7.6%). Age, New York Heart Association (NYHA) class III/IV status and chronic kidney disease predicted mortality in all LVEF groups. Low systolic blood pressure and high heart rate were predictors for mortality in HFrEF and HFmrEF. A lower body mass index was independently associated with mortality in HFrEF and HFpEF patients. Atrial fibrillation predicted mortality in HFpEF patients.Conclusions Heart failure patients stratified according to different categories of LVEF represent diverse phenotypes of demography, clinical presentation, aetiology and outcomes at 1 year. Differences in predictors for mortality might improve risk stratification and management goals.