Prevalence and Long-Term Survival After Coronary Artery Bypass Grafting in Women and Men With Heart Failure and Preserved Versus Reduced Ejection Fraction
Prevalence and Long-Term Survival After Coronary Artery Bypass Grafting in Women and Men With Heart Failure and Preserved Versus Reduced Ejection Fraction
复制标题
DOI：
10.1161/jaha.118.008902
复制
发表时间：
2018-06-19
影响因子：
5.4
通讯作者：
Liu, Peter P.
中科院分区：
文献类型：
--
作者：
Sun, Louise Y.;Tu, Jack, V;Liu, Peter P.
背景-射血分数(REF)降低的心力衰竭(HF)被广泛认为是冠状动脉旁路移植术后的预测指标。射血分数(PEF)保留的心衰占所有心衰病例的一半以上，在住院队列中与相当大的发病率和死亡率有关。然而，心脏外科患者的HFpEF结果尚未阐明。我们调查了冠状动脉搭桥术后女性和男性的HFpEF和HFrEF的患病率和结局。方法和结果-我们使用心脏护理网络和加拿大卫生信息研究所的数据，于2008年10月1日至2015年3月31日在加拿大安大略省进行了一项回顾性队列研究。通过一个有效的基于人群的数据库捕获患有医生诊断的所有安大略省人的心力衰竭。我们将PEF定义为射血分数=50%，REF定义为射血分数50%。主要结果是全因死亡。分析是按性别分层的。死亡率采用Kaplan-Meier法计算。死亡的相对危险性采用多变量Cox比例风险模型进行评估。在40083例患者(20.6%女性)中，55.5%有PEF而无心衰，25.7%有REF而无心衰，6.9%有HFpEF，12.0%有HFrEF。在4+/-2年的随访中，女性和男性的年龄标准化HFpEF死亡率是相似的。HFrEF标准化HFpEF死亡率女性高于男性。结论：我们发现女性HFpEF患病率较高，预后较差。心衰病史是比射血分数更重要的预测指标。术前筛查和延长的术后随访应该集中在患有心衰的男女患者身上，而不是仅仅针对REF。
Background-Heart failure (HF) with reduced ejection fraction (rEF) is a widely regarded prognosticator after coronary artery bypass grafting. HF with preserved ejection fraction (pEF) accounts for up to half of all HF cases and is associated with considerable morbidity and mortality in hospitalized cohorts. However, HFpEF outcomes have not been elucidated in cardiac surgical patients. We investigated the prevalence and outcomes of HFpEF and HFrEF in women and men following coronary artery bypass grafting.Methods and Results-We conducted a retrospective cohort study in Ontario, Canada, between October 1, 2008, and March 31, 2015, using Cardiac Care Network and Canadian Institute of Health Information data. HF is captured through a validated population-based database of all Ontarians with physician-diagnosed HF. We defined pEF as ejection fraction >= 50% and rEF as ejection fraction < 50%. The primary outcome was all-cause mortality. Analyses were stratified by sex. Mortality rates were calculated using Kaplan-Meier method. The relative hazard of death was assessed using multivariable Cox proportional hazard models. Of 40 083 patients (20.6% women), 55.5% had pEF without HF, 25.7% had rEF without HF, 6.9% had HFpEF, and 12.0% had HFrEF. Age-standardized HFpEF mortality rates at 4 +/- 2 years of follow-up were similar in women and men. HFrEF standardized HFpEF mortality rates were higher in women than men.Conclusions-We found a higher prevalence and poorer prognosis of HFpEF in women. A history of HF was a more important prognosticator than ejection fraction. Preoperative screening and extended postoperative follow-up should be focused on women and men with HF rather than on rEF alone.