Severity of left ventricular remodeling defines outcomes and response to therapy in heart failure valsartan - Heart failure trial (Val-HeFT) echocardiographic data
Severity of left ventricular remodeling defines outcomes and response to therapy in heart failure valsartan - Heart failure trial (Val-HeFT) echocardiographic data
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DOI：
10.1016/j.jacc.2003.12.053
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发表时间：
2004-06-02
影响因子：
24
通讯作者：
Cohn, JN
中科院分区：
文献类型：
--
作者：
Wong, ML;Staszewsky, L;Cohn, JN
本研究的目的是检验左心室重构的严重程度预测慢性心力衰竭治疗反应和预后的假设。背景重构的恢复应该在重构最严重的患者中产生最有利的预后。在参与研究前必须满足合格标准的研究中心读取左心室舒张内径（LVIDd）和射血分数（EF）的连续记录。汇总各治疗组的基线LVIDd和EF，并按Q1至Q4四分位数（代表最佳至最差）进行回顾性分组。Kaplan-Meier生存曲线采用log-rank检验。根据考克斯回归风险比（RR）比较Q1与Q4的死亡率和合并死亡率和发病率（M + M）。采用协方差分析的四分位数分析缬沙坦与安慰剂相比LVIDd和EF较基线的变化。通过M + M的RR比较缬沙坦和安慰剂。结果LVIDd和EF较好的四分位数的生存率更高（p < 0.00001）。对于LVIDd和EF，事件中Q1与Q4的RR接近0.5（p < 0.0001）。LVIDd降低和EF增加具有四分位数依赖性，在几乎所有时间点，缬沙坦组均大于安慰剂组。RR为M + M的结果有利于缬沙坦在更坏的quartiles.CONCLUSIONS分层的基线严重程度的重塑显示，左室舒张末内径和射血分数差的患者是在一个事件的风险最高，但似乎获得最多的抗重塑效果和临床获益与缬沙坦治疗。(C)2004年，美国心脏病学会基金会。
OBJECTIVES The objective of this study was to test the hypothesis that the severity of left ventricular remodeling predicts the response to treatment and outcomes in chronic heart failure.BACKGROUND Reversal of remodeling should produce the most favorable outcome in patients with the most severe remodeling.METHODS In 5,010 heart failure patients on background therapy and randomized to valsartan and placebo, serial recordings of left ventricular internal diastolic diameter (LVIDd) and ejection fraction (EF) were read at sites that had to meet qualifying standards before participating. Baseline LVIDd and EF were pooled across treatments and retrospectively grouped by quartiles Q1 to Q4, representing best to worst. Kaplan-Meier survival curves were obtained by the log-rank test. Q1 was compared with Q4 for mortality and combined mortality and morbidity (M + M) from Cox regression risk ratios (RRs). Valsartan versus placebo changes from baseline in LVIDd and EF were analyzed by quartiles from analysis of covariance. Valsartan and placebo were compared by RRs for M + M.RESULTS Survival rates were greater in the better quartiles for LVIDd and EF (p < 0.00001). The RR for Q1 versus Q4 in events approached 0.5 for both LVIDd and EF (p < 0.0001). An LVIDd decrease and EF increase were quartile-dependent and greater with valsartan than placebo at virtually all time points. The RR for M + M outcomes favored valsartan in the worse quartiles.CONCLUSIONS Stratification by baseline severity of remodeling showed that patients with worse LVIDd and EF are at highest risk for an event, yet appear to gain the most anti-remodeling effect and clinical benefit with valsartan treatment. (C) 2004 by the American College of Cardiology Foundation.