Heart Failure Stages Among Older Adults in the Community: The Atherosclerosis Risk in Communities Study.
Heart Failure Stages Among Older Adults in the Community: The Atherosclerosis Risk in Communities Study.
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DOI：
10.1161/circulationaha.116.023361
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发表时间：
2017-01-17
期刊：
影响因子：
37.8
通讯作者：
Solomon SD
中科院分区：
文献类型：
--
作者：
Shah AM;Claggett B;Loehr LR;Chang PP;Matsushita K;Kitzman D;Konety S;Kucharska-Newton A;Sueta CA;Mosley TH;Wright JD;Coresh J;Heiss G;Folsom AR;Solomon SD
尽管心力衰竭对老年人的影响尤为严重，但关于美国心脏病学会/美国心脏协会心力衰竭 (HF) 阶段在社区老年人中的患病率的数据却很少。此外，当代纵向应变（LS）和舒张功能障碍的测量在定义心力衰竭阶段中的作用尚不清楚。社区动脉粥样硬化风险研究中的 6,118 名参与者（年龄 67 – 91 岁）在第五次研究访视时的心力衰竭分期如下：A 期（无症状，有心力衰竭危险因素，但无心脏结构或功能异常），B 期（无症状，有结构异常，定义为左心室肥厚、扩张或功能障碍，或明显瓣膜疾病）、C1 期 （未经住院治疗的临床心力衰竭）和 C2（未经住院治疗的临床心力衰竭）。使用心力衰竭分期的传统定义，只有 5% 的受检查参与者不存在心力衰竭危险因素或结构性心脏病（0 期），52% 属于 A 期，30% 属于 B 期，7% 属于 C1 期，6% 属于 C2 期。中位随访 608 天时，心力衰竭分期越差，发生心力衰竭住院或死亡的风险越大。 C1 和 C2 阶段 LVEF 分别保持在 77% 和 65%。将 LS 和舒张功能障碍纳入 B 阶段定义中，将 14% 的样本从 A 阶段重新分类为 B 阶段，并改善了净重新分类指数 (p=0.028) 和综合辨别指数 (p=0.016)。左心室结构异常、收缩功能（基于 LVEF 和 LS）和舒张功能（基于 e'、E/e' 和左心房容积指数）分别与 A 和 B 阶段参与者的心力衰竭住院或死亡风险独立且相加相关。社区中的大多数老年人都面临心力衰竭（A 期或 B 期）的风险，与之前针对年轻社区样本的报告相比，该风险明显更高。至少三分之二患有心衰（C 期）的老年人的 LVEF 保持稳定，凸显了老年人 HFpEF 的负担。在识别有心力衰竭住院或死亡风险的患者方面，左心室舒张功能和 LS 提供了超越左心室结构和 LVEF 传统测量方法的增量预后价值。
Although HF disproportionately affects older adults, little data exist regarding the prevalence of American College of Cardiology/American Heart Association heart failure (HF) stages among older individuals in the community. Additionally, the role of contemporary measures of longitudinal strain (LS) and diastolic dysfunction in defining HF stages is unclear. HF stages were classified in 6,118 participants in the Atherosclerosis Risk in Communities study (age 67 – 91 years) at the fifth study visit as follows: stage A (asymptomatic with HF risk factors but no cardiac structural or functional abnormalities), B (asymptomatic with structural abnormalities, defined as left ventricular hypertrophy, dilation or dysfunction, or significant valvular disease), C1 (clinical HF without prior hospitalization), and C2 (clinical HF with prior hospitalization). Using the traditional definitions of HF stages, only 5% of examined participants were free of HF risk factors or structural heart disease (Stage 0), 52% were categorized as Stage A, 30% Stage B, 7% Stage C1, and 6% Stage C2. Worse HF stage was associated with a greater risk of incident HF hospitalization or death at a median follow-up of 608 days. LVEF was preserved in 77% and 65% in Stages C1 and C2 respectively. Incorporation of LS and diastolic dysfunction into the Stage B definition reclassified 14% of the sample from Stage A to B and improved the net reclassification index (p=0.028) and integrated discrimination index (p=0.016). Abnormal LV structure, systolic function (based on LVEF and LS), and diastolic function (based on e′, E/e′, and left atrial volume index) were each independently and additively associated with risk of incident HF hospitalization or death in Stage A and B participants. The majority of older adults in the community are at risk for HF (Stages A or B), appreciably more compared to previous reports in younger community-based samples. LVEF is robustly preserved in at least two-thirds of older adults with prevalent HF (Stage C), highlighting the burden of HFpEF in the elderly. LV diastolic function and LS provide incremental prognostic value beyond conventional measures of LV structure and LVEF in identifying persons at risk for HF hospitalization or death.