血浆脑钠肽对左室射血分数保留的慢性心力衰竭患者预后的预测价值

目的:观察血浆脑钠肽(BNP)对左室射血分数保留的慢性心力衰竭(HFpEF)患者的预测价值。方法:2014年～2016年我院CHF患者122例,根据LVEF,患者被分为LVEF减低心衰(HFrEF)组(LVEF≤40%,41例)、中间值LVEF心衰(HFmEF)组(40%LVEF50%,40例)和HFpEF组(LVEF≥50%,41例)。收集、测量比较三组临床资料、血浆BNP水平等指标;ROC曲线分析血浆BNP预测CHF患者短期主要不良终点事件(SMAE)的界值和价值;COX风险回归模型分析预测上述三组SMAE的危险因素。结果:LVEDd:HFpEF组HFmEF组HFrEF组,两两比较均有显著差异,P均=0.001。HFpEF组、HFmEF组LAD显著大于HFrEF组,P均0.05。与HFpEF组比较,HFmEF组和HFrEF组的血浆BNP[(789.39±455.62)pg/ml比(1143.40±567.99)pg/ml比(2341.51±1029.99)pg/ml]水平显著升高,且HFrEF组的显著高于HFmEF组,P均0.01。多因素Logistic回归结果显示血浆BNP水平是HFmEF、HFrEF患者SMAE事件的独立危险因素(OR=1.006,1.001,P均0.05)。ROC曲线分析显示,血浆BNP预测CHF患者SMAE的AUC=0.818,界值为1415pg/ml,敏感度和特异度分别为82.6%和72.7%。三组间住院期间及出院后12个月随访期内的再住院及死亡率无显著差异,P=0.328。结论:血浆BNP对HFmEF和HFrEF患者的短期再入院和死亡事件有良好的预测价值,但不能预测HFpEF患者的终点事件。     

不同类型老年慢性心力衰竭患者心血管及非心血管慢性病负担比较

目的 分析3种不同类型老年慢性心力衰竭(CHF)患者合并常见心血管及非心血管慢性病负担的差异。方法 回顾性分析2008年2月至2019年12月解放军总医院住院的老年CHF患者4650例，根据LVEF分为射血分数减低的心力衰竭(HFrEF)组1627例(LVEF<40%)、射血分数中间值的心力衰竭(HFmrEF)组723例(LVEF 40%～49%)和射血分数保留的心力衰竭(HFpEF)组2300例(LVEF≥50%),对比3组合并18种常见心血管及非心血管慢性病的患病情况、疾病数目及组合情况。结果 老年CHF患者合并心血管疾病数目(1.12±0.73)种，合并非心血管疾病(2.90±1.32)种，HFpEF组合并心血管疾病、非心血管疾病及所有慢性病数目分别为(1.17±0.70)种，(3.06±1.37)种，(4.23±1.67)种，HFpEF组合并5种及6种疾病高于HFrEF组和HFmEF组(P<0.05)。血脂异常&贫血&慢性肾脏病、血脂异常&冠心病&高血压&贫血分别是最常见的三元非心血管疾病多病组合和四元所有慢性病多病组合形式。...     

射血分数保留的心力衰竭治疗及研究进展

正我国成年人群中,心力衰竭(心衰)患病率约为0.9%,其中射血分数保留的心力衰竭(HFpEF)占50%以上~([1])。HFpEF患者的治疗面临巨大挑战,本文拟从药物治疗和非药物治疗两方面介绍HFpEF的治疗研究进展。心衰是多种原因导致心脏结构和/或功能的异常改变,使心室收缩和/或舒张功能发生障碍,从而引起的一组复杂临床综合征,主要表现为呼吸困难、疲乏和液体潴留(肺淤血、体循环淤血及外周水肿)等。根据左室射血分数(LVEF)不同,分为射血分数保留的心衰(HFpEF),LVEF≥50%;射血分数中间值的心衰(HFmrEF),LVEF 40%～49%;射血分数降低的心衰(HFrEF),LVEF40%。对于HFpEF患者的治疗,目前尚无公认有效的治疗方案,主要针对症状、心血管基础疾病合并症、危险因素等,采取综合性治疗手段~([2])。     

射血分数正常的心力衰竭患者研究

目的探讨射血分数正常心力衰竭(HFpEF)患者临床特征及预后。方法选取我院2016年7月～2017年12月收治的153例HFpEF患者,另取同期收治的149例射血分数降低心力衰竭(HFrEF)患者作为研究对象。收集两组临床资料,包括一般资料、合并症、心功能指标[左室射血分数(LVEF)、升主动脉内径(AAO)、主动脉根部内径(AOR)、左心房内径(LAD)、室间隔舒张末期厚度(IVST)、左心室舒张末期内径(LVEDd)、相对室壁厚度(RWT)]、实验室指标[脑钠肽(BNP)、血红蛋白(Hb)、肌钙蛋白T(TnT)、C反应蛋白(CRP)]。两组均接受常规抗心衰及对症治疗,随访1年,统计对比不良事件发生率。结果 HFpEF组女性患者占值高于HFrEF组,且年龄、收缩压大于HFrEF组(P0.05);HFpEF组高血压、贫血及心房颤动患者占值高于HFrEF组(P0.05);HFpEF组LVEF、IVST、RWT大于HFrEF组,AOR、LVEDd小于HFrEF组(P0.05);HFpEF组血浆BNP水平及血清Hb水平低于HFrEF组(P0.05);随访1年,HFpEF因心脏事件反复住院率及心源性死亡率与HFrEF组比较无显著差异(P0.05)。结论 HFpEF患者临床特征与HFrEF虽存在明显差异,但预后与HFrEF无明显差异,其防治工作临床仍不容忽视。     

老年射血分数中间值心力衰竭患者的临床特点分析

目的了解老年射血分数中间值的心力衰竭(HFmrEF)患者与射血分数减低的心力衰竭(HFrEF)及射血分数保留的心力衰竭(HFpEF)患者的病因、临床特点和治疗情况差异。方法入选2016年1月~2017年1月我院心力衰竭中心因心力衰竭住院的年龄≥60岁患者385例,按LVEF分为HFrEF组96例、HFmrEF组34例和HFpEF组255例。收集患者的人口学资料、心力衰竭病因、临床特点、心脏超声、检验结果和治疗情况,比较各组患者临床综合特征的差异。结果 HFmrEF组高血压比例最高(67.7%),瓣膜疾病比例次之(29.0%)。HFmrEF组住院期间静脉用硝酸酯类(44.1%vs 25.0%和16.5%)、出院肌酐[(131.66±55.7)μmol/L vs(80.49±33.97)μmol/L和(85.50±37.81)μmol/L]明显高于HFrEF组和HFpEF组;应用螺内酯和米力农的比例低于HFrEF组,而高于HFpEF组(P0.05,P0.01)。结论高血压、瓣膜疾病是老年HFmrEF的主要病因;且以男性和心功能Ⅳ级居多;此类患者出院肌酐水平偏高;同时,这部分老年心衰患者的转归尚可。     

射血分数保留心力衰竭的临床特征及预后因素分析

目的:比较射血分数保留心力衰竭(HFpEF)的临床特征及预后因素分析。方法:将523例心力衰竭(心衰)患者按左室射血分数分为射血分数降低心衰(HFrEF)、射血分数中间范围型心衰(HFmrEF)和HFpEF,比较其临床特征、观察预后指标差异。将274例HFpEF住院患者按年龄分为≥65岁组(228例)和65岁组(46例),分析≥65岁组HFpEF患者心衰再次住院危险因素。结果:与HFrEF患者相比,HFpEF患者年龄、BMI、胆固醇、白蛋白更高,女性患者更多,心率、肌钙蛋白-I、脑钠肽(BNP)、胆红素、尿酸、水肿更少,住院时间较短、住院期间全因死亡率、入院后30d全因死亡率更低(均P0.05)。与HFmrEF患者相比,HFpEF年龄更大、女性更多,三酰甘油、高密度脂蛋白更高,心率、肌钙蛋白-I、BNP、胆红素、尿酸、白细胞、尿素氮更低,住院时间更短(均P0.05)。年龄、尿素氮、心率增高,住院时间延长为HFpEF患者全因死亡的独立危险因素。高龄、合并心房颤动多为≥65岁HFpEF患者出院1年内心衰再次住院的独立危险因素。结论:HFpEF患者近期、远期预后较差,HFpEF有不同于HFrEF、HFmrEF的临床特征,可能需要采取不同的防治方案。     

缺血性心肌病合并射血分数改善的心力衰竭患者的临床特征及预后研究

目的 探讨缺血性心肌病（ICM）合并射血分数改善的心力衰竭（HFimpEF）患者的临床特征及预后。方法 选取2018年6月至2021年5月河北省人民医院心脏中心收治的ICM合并慢性心力衰竭（HF）患者425例。根据基线、复查左心室射血分数（LVEF）将其分为HFimpEF组（基线LVEF≤40%，复查LVEF>40%,n=95）、射血分数中间值的心力衰竭（HFmrEF）组（复查LVEF为41%～49%,n=84）、射血分数降低的心力衰竭（HFrEF）组（基线LVEF≤49%，复查LVEF≤40%,n=178）、射血分数保留的心力衰竭（HFpEF）组（基线LVEF及复查LVEF均≥50%,n=68）。比较四组一般资料、超声心动图检查指标、实验室检查指标、治疗情况、全因死亡率、全因再入院率。采用单因素、多因素Cox比例风险回归分析探讨ICM合并HFimpHF患者全因死亡、全因再入院的影响因素。结果 HFimpEF组年龄小于HFpEF组，收缩压（SBP）低于HFpEF组，舒张压（DBP）低于HFrEF组（P<0.05）;HFimpEF组基线左心室收缩末期内径（LVESD）、左心室...     

不同左心室射血分数心力衰竭住院患者的临床特征、诊疗情况及结局差异

目的:分析不同左心室射血分数(LVEF)心力衰竭(心衰)住院患者临床特征、院内诊疗及6个月结局差异。方法:从重大慢病国家注册登记研究心衰前瞻队列研究中选取2016年8月至2017年7月全国50家医院连续纳入的18岁以上心衰住院患者,根据LVEF分为射血分数减低的心衰(HFr EF,LVEF 40%)组、射血分数中间值的心衰(HFmrEF,40%≤LVEF50%)组、射血分数保留的心衰(HFpEF,LVEF≥50%)组。比较三组患者的临床特征、院内治疗情况和6个月全因死亡风险。结果:共入选2 781例心衰住院患者,中位年龄67(57,75)岁,37.9%为女性;HFr EF组1 031例(37.1%),HFmrEF组643例(23.1%),HFpEF组1 107例(39.8%)。HFmrEF组患者中位年龄(67岁)高于HFr EF组(62岁),但低于HFpEF组(71岁),HFpEF组的女性比例(51.4%)高于HFr EF组(23.9%)和HFmrEF组(37.3%),差异均有统计学意义(P均0.017)。全部心衰患者中合并比例最高的疾病为高血压(56.4%)、心房颤动(29.5%)和糖尿病(28.3%)。HFmrEF组和HFpEF组高血压(HFmrEF组vs. HFpEF组vs. HFr EF组:60.5%vs. 63.0%vs. 46.8%)和心房颤动(HFmrEF组vs. HFpEF组vs. HFr EF组:32.2%vs. 35.6%vs. 21.3%)的合并比例均明显高于HFr EF组(P均0.017)。HFmrEF组住院期间血管紧张素转换酶抑制剂或血管紧张素Ⅱ受体拮抗剂、醛固酮受体拮抗剂和β受体阻滞剂的使用率分别为66.4%、85.1%、74.5%,HFpEF组分别为55.2%、76.4%、64.1%,两组均低于HFr EF组(75.8%、90.1%、81.2%,P均0.017)。HFmrEF组(HR=0.696,95%CI:0.510～0.951,P=0.02)和HFpEF组(HR=0.493,95%CI:0.366～0.665,P0.01)患者6个月死亡风险均低于HFr EF组患者。结论:本研究中,HFpEF患者和HFmrEF患者在全部心衰住院患者中分别占四成和近四分之一。HFpEF患者和HFmrEF患者的临床特征与HFr EF患者不同,治疗模式相似,出院6个月死亡风险均低于HFr EF患者。     

射血分数保留与射血分数降低的充血性心力衰竭患者左室结构和功能比较

目的 探讨射血分数保留充血性心力衰竭(HFpEF)与射血分数降低充血性心力衰竭(HFrEF)患者的左室结构和左室收缩功能的变化。方法 入选HFpEF及HFrEF患者各40例。入组者行超声心动图检查。经核素心血池显像测定分级小剂量多巴酚丁胺负荷后心率（HR）及左室收缩功能指标左室射血分数（LVEF）、高峰射血率（PER）、高峰射血时间（TPER）最大变化率。比较HFpEF及HFrEF患者6个月预后,观测HFpEF患者6个月后LVEF变化。结果 HFpEF组患者左房内径（LAD）、左室收缩期末内径（LVESD）、左室舒张期末内径（LVEDD）显著小于HFrEF组（均P<0.05）;HFpEF组患者室间隔厚度（IVST）、左室后壁厚度(LVPWT)大于HFrEF组（P<0.05）;HFpEF组LVEF在静息及各负荷值较HFrEF组高（P<0.05）,但LVEF最大变化率与HFrEF组比较无统计学意义。两组间PER最大变化率及TPER最大变化率比较无统计学意义。两组6个月内病死率无显著差异。HFpEF组6个月后存活患者有3例LVEF低于50%,发生率为9%。 结论 两组左房室结构存在明显差异,HFrEF组静息LVEF明显低于HFpEF组,但两组左室收缩功能储备基本一致,部分HFpEF患者可演变为HFrEF患者。     

不同类型老年心力衰竭患者QRS波时限及心率变异性与心功能相关性

目的 探讨不同类型老年心力衰竭患者QRS波时限及心率变异性(HRV)与心功能相关性。方法 选取老年心力衰竭患者106例，男66例，女40例，根据左心室射血分数(LVEF)分为射血分数降低心力衰竭(HFrEF)组34例、射血分数中间值心力衰竭(HFmrEF)组33例、射血分数保留心力衰竭(HFpEF)组39例；完善脑钠肽(BNP)、心电图、动态心电图等相关检查。结果 HFrEF组QRS波时限长于HFmrEF组和HFpEF组，差异有统计学意义(P<0.01);HFmrEF组和HFpEF组无统计学差异(P>0.05);HFrEF组左室收缩末期内径(LVESD)明显大于HFmrEF组和HFpEF组(P<0.001),HFmrEF组明显大于HFpEF组(P<0.001);HFrEF组左室舒张末期内径(LVEDD)明显大于HFmrEF组和HFpEF组(P<0.001),HFmrEF组明显大于HFpEF组(P<0.001);3组间HRV时域指标无统计学差异(P>0.05)。相关性分析显示，老年心力衰竭患者QRS波时限与LVEF呈显著负相关性(r=-0.432...     

射血分数中间值的心力衰竭患者的临床特征及预后研究

背景射血分数中间值的心力衰竭(HFmrEF)作为心力衰竭新增分型,其病理生理机制、群体特征、合并症及临床特征与射血分数降低的心力衰竭(HFr EF)患者不尽相同。目的探讨HFmr EF患者的临床特征及预后,以期为HFmr EF患者的临床诊治提供一定参考。方法本研究为回顾性研究。选取2016年6月—2019年6月在石河子大学医学院第一附属医院血管内科住院治疗的心力衰竭患者654例作为研究对象,根据左心室射血分数(LVEF)分为HFr EF组(LVEF <40%,n=299)、HFmr EF组(40≤LVEF <50%,n=153)和射血分数保留的心力衰竭(HFp EF)组(LVEF≥50%,n=202)。收集三组患者基线资料、入院24 h内实验室检查指标及超声心动图检查指标。所有患者均随访1年,记录患者全因死亡情况和全因死亡时间、因心力衰竭再入院情况和因心力衰竭再入院时间。结果HFmr EF组与HFr EF组患者年龄小于HFp EF组,HFr EF组患者年龄小于HFmr EF组(P <0.05);HFr EF组患者女性占比低于HFmr EF组与HFp EF组(P <0.05);HFmr EF组与HFr EF组患者心率大于HFp EF组,纽约心脏病协会(NYHA)分级优于HFp EF组,有糖尿病病史、陈旧性心肌梗死病史者所占比例高于HFp EF组,有心房颤动病史、慢性阻塞性肺疾病(COPD)病史者所占比例低于HFp EF组(P <0.05)。HFmr EF组与HFr EF组患者血肌酐、血尿酸、空腹血糖、中性粒细胞与淋巴细胞比值(NLR)及氨基末端脑钠肽前体(NT-pro BNP)高于HFp EF组,高密度脂蛋白低于HFp EF组(P <0.05);HFr EF组患者血肌酐、血尿酸、空腹血糖、NLR及NT-pro BNP高于HFmr EF组,高密度脂蛋白低于HFmr EF组(P <0.05)。HFmr EF组和HFr EF组患者左心房内径和左心室舒张末期内径(LVEDD)大于HFp EF组,HFr EF组患者左心房内径和LVEDD大于HFmr EF组(P <0.05)。Spearman秩相关分析结果显示,心力衰竭分型与血肌酐(r=0.110)、血尿酸(r=0.264)、空腹血糖(r=0.139)、NLR(r=0.415)、NT-pro BNP(r=0.571)、左心房内径(r=0.246)及LVEDD(r=0.607)呈正相关,与高密度脂蛋白(r=-0.144)呈负相关(P <0.05)。本组患者随访过程中失访18例,失访率为2.7%,平均随访(12.0±1.6)个月。生存曲线分析结果显示,HFr EF组患者1年累积生存率和1年累积无心力衰竭再入院率低于HFp EF组和HFmr EF组,HFmr EF组患者1年累积无心力衰竭再入院率低于HFp EF组(P <0.05)。结论 HFmr EF患者的临床特征与HFr EF相似,其心力衰竭严重程度及左心室重构程度介于HFr EF与HFp EF之间,其1年累积生存率与HFp EF患者相似,均优于HFr EF患者,但其1年累积无心力衰竭再入院率低于HFpEF患者。     

Sedentary Time and Cumulative Risk of Preserved and Reduced Ejection Fraction Heart Failure: From the Multi-Ethnic Study of Atherosclerosis

BackgroundThis study examined the relationship between self-reported sedentary time (ST) and the cumulative risk of heart failure with preserved ejection fraction (HFpEF) and reduced ejection fraction (HFrEF) in a diverse cohort of U.S. adults 45–84 years of age.Methods and ResultsUsing data from the Multi-Ethnic Study of Atherosclerosis (MESA), we identified 6,814 subjects, all free of baseline cardiovascular disease. Cox regression was used to calculate the hazard ratios (HR) associated with risk of HFpEF and HFrEF. Weekly ST was dichotomized based on the 75th percentile (1890 min/wk). During ～11.2 years of follow-up there were 178 first incident HF diagnoses: 74 HFpEF and 69 HFrEF. Baseline ST >1890 min/wk was significantly associated with an increased risk of HFpEF (HR 1.87, 95% confidence interval [CI] 1.13–3.09, P = .01), but not of HFrEF. The relationship with HFpEF remained significant in fully adjusted models including physical activity and waist circumference (HR 2.16, 95% CI 1.23–3.78, P < .01). In addition, every 60-minute increase in weekly ST was associated with a 3% increased risk of HFpEF (HR 1.03, 95% CI 1.01–1.05, P < .01).ConclusionsSedentary time >1890 min/wk (～4.5 h/d) is a significant predictor of HFpEF, independently from physical activity and adiposity.     

左心室射血分数保留性心力衰竭患者预后相关生物靶向标志物的表达特征

目的分析射血分数下降的心力衰竭(heart failure with reduced ejection fraction,HFrEF)和射血分数保留(或正常)的心力衰竭(heart failure with preserved ejection fraction,HFpEF)患者生物靶向标志物表达差异情况。评估生物靶向标志物对HFpEF识别与预后判断价值。方法连续选择2015年1月至2016年5月香港大学深圳医院100例HFpEF(左心室射血分数≥50%)及310例HFrEF(左心室射血分数<50%)患者,收集患者基本临床治疗与相关生物靶向标志物,以12个月不良事件为研究终点。结果HFpEF患者中,氨基末端脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)浓度[1911(877~4130)pg/mL vs.3001(1498~6120)pg/mL,P<0.05]、高敏肌钙蛋白T(high-sensitivity troponin T,hsTnT)浓度[21.1(15.9~41)pg/mL vs.31.2(18.1~52.7)pg/mL,P<0.05]、高敏C-反应蛋白(high-sensitivity C-reactive protein,hs-CRP)浓度[3.6(1.7~6.9)mg/L vs.2.1(0.9~4.8)mg/L,P<0.05]明显低于HFrEF患者,而胱抑素C浓度高于HFrEF患者[1.7(1.3~2.2)mg/L vs.1.4(1.0~2.0)mg/L,P<0.05],差异有统计学意义。而且在HFpEF组中白细胞介素-6,hsTnT和尿素氮与终点事件有关,NT-proBNP对HFpEF患者远期预后无统计学意义。结论生物标志物在HFpEF与HFrEF患者中存在差异性表达情况。在HFpEF患者中,预后相关的预测因子可能进一步提高临床对于HFpEF诊断、风险评估与治疗。     

Glycemic Markers and Heart Failure Subtypes: The Multi-Ethnic Study of Atherosclerosis (MESA)

BackgroundAlthough diabetes increases heart failure (HF) risk, it is unclear how various dysglycemia markers (hemoglobin A_1C [HbA_1C], fasting plasma glucose [FPG], homeostasis model assessment of insulin resistance, and fasting insulin) are associated with HF subtypes (HF with preserved ejection fraction [HFpEF] and HF with reduced ejection fraction [HFrEF]). We assessed the relation of markers of dysglycemia and risks of HFpEF and HFrEF.Methods and ResultsWe included 6688 adults without prevalent cardiovascular disease who attended the first MESA visit (2000–2002) and were followed for incident hospitalized HF (HFpEF or HFrEF). Association of glycemic markers and status (normoglycemia, prediabetes, diabetes) with HFpEF and HFrEF were evaluated using adjusted Cox models. Over a median follow-up of 14.9 years, there were 356 HF events (145 HFpEF, 173 HFrEF, and 38 indeterminate HF events). Diabetes status conferred higher risks of HFpEF (hazard ratio [HR] 1.85, 95% confidence interval [CI] 1.57–2.68) and HFrEF (HR 2.02, 95% CI 1.38–2.97) compared with normoglycemia. Higher levels of FPG (≥126 mg/dL) and HbA_1C (≥6.5%) were associated with similarly higher risks of HFpEF (HR for FPG 1.96, 95% CI 1.21–3.17; HR for HbA_1C 2.00, 95% CI 1.20–3.31) and HFrEF (HR for FPG 1.84, 95% CI 1.18–2.88; HR for HbA_1C 1.99, 95% CI 1.28–3.09) compared with reference values. Prediabetic range HbA_1C (5.7%–6.4%) or FPG (100%–125 mg/dL), homeostasis model assessment of insulin resistance, and fasting insulin were not significantly associated with HFpEF or HFrEF.ConclusionsAmong community-dwelling individuals, HbA_1C and FPG in the diabetes range were each associated with higher risks of HFpEF and HFrEF, with similar magnitudes of their associations.Lay AbstractHeart failure (HF) has 2 major subtypes (the heart's inability to pump or to fill up). Diabetes is known to increase HF risk, but its effects and that of markers of high glucose levels (fasting blood glucose and hemoglobin A_1C) on the occurrence of HF subtypes remains unknown. Among 6688 adults without known cardiovascular disease followed for nearly 15 years, diabetes conferred significantly higher risks of both HF types, compared with those with normal blood glucose levels. Higher levels of fasting blood glucose and hemoglobin A_1C were similarly associated with higher risks of both types of HF.     

Comparing New Onset Heart Failure with Reduced Ejection Fraction and New Onset Heart Failure with Preserved Ejection Fraction: An Epidemiologic Perspective

The incidence and prevalence of heart failure is increasing, especially heart failure with preserved ejection fraction (HFpEF) relative to heart failure with reduced ejection fraction (HFrEF). For both HFrEF and HFpEF, there is need to shift our focus from secondary to primary prevention. Detailed epidemiologic data on both HFpEF and HFrEF are needed to allow early identification of at-risk subjects. Current cohorts with new onset heart failure lack uniformity with respect to diagnosis, follow-up, and population characteristics, but most important, fail to distinguish between HFpEF and HFrEF. Studies on prevalent heart failure show ischemic heart disease as the predominant risk factor for HFrEF, while hypertension, atrial fibrillation, and diabetes are risk factors for HFpEF. As it becomes increasingly clear that both subtypes of heart failure are different syndromes, new cohorts and trials are necessary to obtain separate data on both subtypes of heart failure.     

肺部超声用于分析不同心力衰竭类型的比较及其与其他指标的相关性

目的 比较肺部超声在不同心衰(HF)类型中应用的差异,并分析肺部超声与其他指标的相关性。方法 124例急性HF患者,射血分数(EF)保留型HF组（HFpEF）48例;EF减低型HF组(HFrEF)76例。比较2组间临床资料以及心肺超声指标的差异,并进一步分析肺水B线在两种HF类型中分别与氨基末端脑钠尿肽原（NT-proBNP）、E/e’和左室EF（LVEF）的相关性的差异。结果 HFpEF组和HFrEF组两组患者在基本临床资料方面均无明显统计学差异; HFpEF组的LVEF、室间隔厚度明显高于HFrEF组,而左室舒张末期内径、左室收缩末期内径、下腔静脉直径均明显小于HFrEF组。两组患者的左房前后径、E/A、肺动脉压（PAP）、E/e’和B线均无明显统计学差异。在HFpEF组中B线与E/e’的相关性优于NT-proBNP（r=0.886,r=0.755）,而在 HFrEF组中肺水B线与NT-proBNP的相关性优于E/e’（r=0.829,r=0.737）。结论 无论HFpEF,还是HFrEF,B线与NT-proBNP、E/e’均有良好的正相关性。     

Worsening Renal Function and Outcome in Heart Failure Patients With Preserved Ejection Fraction and the Impact of Angiotensin Receptor Blocker Treatment

Background

Worsening renal function (WRF) associated with renin-angiotensin-aldosterone system (RAAS) inhibition does not confer excess risk in heart failure patients with reduced ejection fraction (HFrEF).

Objectives

The goal of this study was to investigate the relationship between WRF and outcomes in heart failure patients with preserved ejection fraction (HFpEF) and the interaction with RAAS blockade.

Methods

In 3,595 patients included in the I-PRESERVE (Irbesartan in Heart Failure With Preserved Ejection Fraction) trial, change in estimated glomerular filtration rate (eGFR) and development of WRF after initiation of irbesartan or placebo were examined. We examined the association between WRF and the first occurrence of cardiovascular death or heart failure hospitalization (primary outcome in this analysis) and the interaction with randomized treatment.

Results

Estimated GFR decreased early with irbesartan treatment and remained significantly lower than in the placebo group. WRF developed in 229 (6.4%) patients and occurred more frequently with irbesartan treatment (8% vs. 4%). Overall, WRF was associated with an increased risk of the primary outcome (adjusted hazard ratio [HR]: 1.43; 95% confidence interval [CI]: 1.10 to 1.85; p = 0.008). Although the risk related to WRF was greater in the irbesartan group (HR: 1.66; 95% CI: 1.21 to 2.28; p = 0.002) than with placebo (HR: 1.09; 95% CI: 0.66 to 1.79; p = 0.73), the interaction between treatment and WRF on outcome was not significant in an adjusted analysis.

Conclusions

The incidence of WRF in HFpEF was similar to that previously reported in HFrEF but more frequent with irbesartan than with placebo. WRF after initiation of irbesartan treatment in HFpEF was associated with excess risk, in contrast to WRF occurring with RAAS blockade in HFrEF.     

Multiple Prior Live Births Are Associated With Cardiac Remodeling and Heart Failure Risk in Women

ObjectiveGreater parity has been associated with cardiovascular disease risk. We sought to find whether the effects on cardiac remodeling and heart failure risk are clear.MethodsWe examined the association of number of live births with echocardiographic measures of cardiac structure and function in participants of the Framingham Heart Study (FHS) using multivariable linear regression. We next examined the association of parity with incident heart failure with preserved (HFpEF) or reduced (HFrEF) ejection fraction using a Fine-Gray subdistribution hazards model in a pooled analysis of n = 12,635 participants in the FHS, the Cardiovascular Health Study, the Multi-Ethnic Study of Atherosclerosis, and Prevention of Renal and Vascular Endstage Disease. Secondary analyses included major cardiovascular disease, myocardia infarction and stroke.ResultsAmong n = 3931 FHS participants (mean age 48 ± 13 years), higher numbers of live births were associated with worse left ventricular fractional shortening (multivariable β -1.11 (0.31); P = 0.0005 in ≥ 5 live births vs nulliparous women) and worse cardiac mechanics, including global circumferential strain and longitudinal and radial dyssynchrony (P < 0.01 for all comparing ≥ 5 live births vs nulliparity). When examining HF subtypes, women with ≥ 5 live births were at higher risk of developing future HFrEF compared with nulliparous women (HR 1.93, 95% CI 1.19–3.12; P = 0.008); by contrast, a lower risk of HFpEF was observed (HR 0.58, 95% CI 0.37–0.91; P = 0.02).ConclusionsGreater numbers of live births are associated with worse cardiac structure and function. There was no association with overall HF, but a higher number of live births was associated with greater risk for incident HFrEF.     

Riser Pattern: Another Determinant of Heart Failure With Preserved Ejection Fraction

Paradoxical increase in blood pressure (BP) during sleep, exceeding those of awake BP, is called the “riser” BP pattern, and known as an abnormal circadian BP rhythm, has been reported to be associated with adverse cardiovascular prognoses. However, the significance of ambulatory BP in heart failure patients with preserved ejection fraction (HFpEF) has never been reported. Here, we tested our hypothesis that abnormal circadian BP rhythm is associated with HFpEF. The authors enrolled 508 patients with hospitalized HF (age 68±13 years; 315 men, 193 women). There were 232 cases of HFpEF and 276 cases of heart failure with reduced ejection fraction (HFrEF). The riser BP pattern was significantly more frequent in the HFpEF (28.9%) group compared with the HFrEF group (19.9%). In a multivariable logistic regression analysis, the riser BP pattern was associated with HFpEF (odds ratio, 1.73; 95% confidence interval, 1.02–2.91; P=.041) independent of the other covariates. In conclusion, the riser BP pattern was associated with HFpEF.     

射血分数降低的心力衰竭患者高肺血管阻力的临床特征和危险因素分析

目的:分析射血分数降低的心力衰竭(HFrEF)患者高肺血管阻力(PVR)的临床特征和危险因素.方法:连续纳入2017年1月至2019年12月在我中心行右心导管检查的HFrEF患者共164例,收集患者的临床和右心导管检查数据.右心导管检查测得PVR≥5.0 Wood单位(WU)定义为PVR显著升高.采用Lasso-Log...