Predicting Heart Failure With Preserved and Reduced Ejection Fraction: The International Collaboration on Heart Failure Subtypes.
Predicting Heart Failure With Preserved and Reduced Ejection Fraction: The International Collaboration on Heart Failure Subtypes.
复制标题
通过保留和减少的射血分数来预测心力衰竭：心力衰竭亚型的国际合作。
DOI：
10.1161/circheartfailure.115.003116
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发表时间：
2016-06
期刊：
影响因子：
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通讯作者：
Larson MG
中科院分区：
文献类型：
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作者：
Ho JE;Enserro D;Brouwers FP;Kizer JR;Shah SJ;Psaty BM;Bartz TM;Santhanakrishnan R;Lee DS;Chan C;Liu K;Blaha MJ;Hillege HL;van der Harst P;van Gilst WH;Kop WJ;Gansevoort RT;Vasan RS;Gardin JM;Levy D;Gottdiener JS;de Boer RA;Larson MG
心力衰竭（HF）是一种流行且致命的疾病，需要针对高危人群采取预防策略。目前的HF预测模型尚未检查HF亚型。我们试图开发和验证射血分数保留和降低的HF（HFpEF，HFrEF）的风险预测模型。在来自四个社区队列的28，820名参与者中，982名在中位随访12年期间发生了HFpEF事件和909名HFrEF事件。将三个队列合并，并以2：1的随机比例进行推导和内部验证，第四个队列作为外部验证。模型考虑了多种竞争风险（死亡、其他HF亚型、未分类HF）。HFpEF特异性模型包括年龄、性别、收缩压、体重指数、抗高血压治疗和既往心肌梗死;其在推导（c-统计量0.80，95% CI 0.78-0.82）和验证样本（内部0.79，95% CI 0.77-0.82;外部0.76，95% CI 0.71-0.80）方面具有良好的区分度。HFrEF特异性模型还包括吸烟、左心室肥大（LVH）、左束支分支传导阻滞（LBBB）和糖尿病;其在推导（c-统计量0.82，95% CI 0.80-0.84）和验证样本（内部0.80，95% CI 0.78-0.83;外部0.76，95% CI 0.71-0.80）方面具有良好的区分度。年龄与HFpEF的相关性更强，男性、LVH、LBBB、既往心肌梗死和吸烟与HFrEF的相关性更强（每次比较的P ≤ 0.02）。我们描述并验证了HF亚型的风险预测模型，并在大样本中显示出良好的区分度。HFpEF和HFrEF之间的一些危险因素不同，支持HF亚型之间的发病差异的概念。
Heart failure (HF) is a prevalent and deadly disease, and preventive strategies focused on at-risk individuals are needed. Current HF prediction models have not examined HF subtypes. We sought to develop and validate risk prediction models for HF with preserved and reduced ejection fraction (HFpEF, HFrEF). Of 28,820 participants from four community-based cohorts, 982 developed incident HFpEF and 909 HFrEF during a median follow-up of 12 years. Three cohorts were combined and a 2:1 random split used for derivation and internal validation, with the fourth cohort as external validation. Models accounted for multiple competing risks (death, other HF subtype, unclassified HF). The HFpEF-specific model included age, sex, systolic blood pressure, body mass index, antihypertensive treatment, and prior myocardial infarction; it had good discrimination in derivation (c-statistic 0.80, 95% CI 0.78–0.82) and validation samples (internal 0.79, 95% CI 0.77–0.82; external 0.76, 95% CI 0.71–0.80). The HFrEF-specific model additionally included smoking, left ventricular hypertrophy (LVH), left bundle branch block (LBBB), and diabetes; it had good discrimination in derivation (c-statistic 0.82, 95% CI 0.80–0.84) and validation samples (internal 0.80, 95% CI 0.78–0.83; external 0.76, 95% CI 0.71–0.80). Age was more strongly associated with HFpEF, and male sex, LVH, LBBB, prior myocardial infarction, and smoking with HFrEF (P for each comparison ≤ 0.02). We describe and validate risk prediction models for HF subtypes, and show good discrimination in a large sample. Some risk factors differed between HFpEF and HFrEF, supporting the notion of pathogenetic differences among HF subtypes.