Left Ventricular Ejection Fraction and Risk of Stroke and Cardiac Events in Heart Failure: Data From the Warfarin Versus Aspirin in Reduced Ejection Fraction Trial.
Left Ventricular Ejection Fraction and Risk of Stroke and Cardiac Events in Heart Failure: Data From the Warfarin Versus Aspirin in Reduced Ejection Fraction Trial.
复制标题
左心室射血分数以及心力衰竭中卒中和心脏事件的风险：在减少射血分数试验中，华法林与阿司匹林的数据。
DOI：
10.1161/strokeaha.116.013679
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发表时间：
2016-08
期刊：
影响因子：
8.3
通讯作者：
WARCEF Investigators
中科院分区：
文献类型：
--
作者：
Di Tullio MR;Qian M;Thompson JL;Labovitz AJ;Mann DL;Sacco RL;Pullicino PM;Freudenberger RS;Teerlink JR;Graham S;Lip GY;Levin B;Mohr JP;Buchsbaum R;Estol CJ;Lok DJ;Ponikowski P;Anker SD;Homma S;WARCEF Investigators
在心力衰竭（HF）中，左心室射血分数（LVEF）与死亡率和心血管（CV）结局呈负相关。它与中风的关系是有争议的，抗血栓治疗的效果也是如此。我们研究了心力衰竭患者LVEF与卒中和CV事件的关系，以及不同抗栓治疗的效果。在华法林与阿司匹林降低射血分数（WARCEF）试验中，2305例收缩期HF （LVEF≤35%）和窦性心律患者被随机分配到华法林或阿司匹林组，随访3.5±1.8年。虽然在主要结局（死亡、中风或脑出血）上观察到两种治疗之间没有差异，但华法林降低了中风的风险。本报告比较了不同LVEF和治疗亚组的卒中和心血管事件发生率。基线LVEF与主要结局、死亡率及其组成部分（猝死和CV死亡）和HF住院呈负相关和线性相关，但与心肌梗死无关。仅在LVEF <15%时观察到与卒中的关系（发病率：2.04 vs. 0.95/100 pt.年；p=0.009），校正后卒中风险增加一倍以上（校正后HR: 2.125, 95% CI 1.182, 3.818; p=0.012）。在华法林治疗的患者中，LVEF每降低5%，卒中风险显著增加（调整后HR: 1.346, 95% CI 1.044, 1.737; p=0.022；相互作用的p值=0.04）。在收缩期心衰和窦性心律患者中，LVEF与死亡及其组成部分呈负相关，而极低的LVEF值与卒中存在关联。可能存在与华法林治疗的相互作用。临床试验注册-网址：http://www.clinicaltrials.gov。唯一标识符：NCT00041938
In heart failure (HF), left ventricular ejection fraction (LVEF) is inversely associated with mortality and cardiovascular (CV) outcomes. Its relationship with stroke is controversial, as is the effect of antithrombotic treatment. We studied the relationship of LVEF with stroke and CV events in HF patients, and the effect of different antithrombotic treatments. In the Warfarin versus Aspirin in Reduced Ejection Fraction (WARCEF) trial, 2305 patients with systolic HF (LVEF ≤ 35%) and sinus rhythm were randomized to warfarin or aspirin and followed for 3.5±1.8 years. While no differences between treatments were observed on primary outcome (death, stroke or intracerebral hemorrhage), warfarin decreased the stroke risk. The present report compares the incidence of stroke and CV events across different LVEF and treatment subgroups. Baseline LVEF was inversely and linearly associated with primary outcome, mortality and its components (sudden and CV death) and HF hospitalization, but not myocardial infarction. A relationship with stroke was only observed for LVEF <15% (incidence rates: 2.04 vs. 0.95/100 pt. yrs; p=0.009), which more than doubled the adjusted stroke risk (adjusted HR: 2.125, 95% CI 1.182, 3.818; p=0.012). In warfarin-treated patients, each 5% LVEF decrement significantly increased the stroke risk (adjusted HR: 1.346, 95% CI 1.044, 1.737; p=0.022; p-value for interaction=0.04). In patients with systolic HF and sinus rhythm, LVEF is inversely associated with death and its components, whereas an association with stroke exists for very low LVEF values. An interaction with warfarin treatment on stroke risk may exist. Clinical Trial Registration - URL:http://www.clinicaltrials.gov. Unique identifier: NCT00041938