Radosław Szczerba, Wiktoria Żelazna, Jakub Sokołowski, Natalia Wyroba, Zuzanna Wydrych, Michał Wita, Małgorzata Cichoń, Michał Orszulak, Katarzyna Mizia-Stec, Krystian Wita, Maciej T Wybraniec
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引用次数: 0
Abstract
Introduction: Heart failure (HF) with improved ejection fraction (HFimpEF) was shown to be related with improved outcome but increase of left ventricular ejection fraction (LVEF) in patients without HF is of less known clinical significance. The aim of the study was to evaluate long-term prognosis in patients with different cardiovascular disorders, with and without HF, depending on temporal variations of LVEF.
Methods: The study covered 31 920 patients (median age 71 years, 37.7% females) with different cardiovascular disorders and at least two measurements of LVEF separated by ≥1 month. Clinical parameters were acquired from database of Academic Repository of Clinical Cases of Medical University of Silesia. HFimpEF was defined by LVEF increase ≥10% in HF patients in relation to baseline value. The endpoints were all-cause mortality and Major Adverse Cardiac and Cerebrovascular Event (MACCE).
Results: The median follow-up time was 51.5 months and LVEF was measured median 2 times. HF was diagnosed in 12 152 patients (38.1%), of which 2 843 (23.4%) experienced HFimpEF. MACCE occurrence was greater in HF than non-HF patients (12.78%/year vs. 6.07%/year, p < 0.001). In patients with HF, Kaplan-Meier survival curves showed significantly lower MACCE occurrence in HFimpEF and stable LVEF than in decreased LVEF (11.46%/year vs. 12.5%/year vs. 21.6%/year; log-rank p = 0.199 and p < 0.001) and HFimpEF constituted one of independent predictors of MACCE (HR = 0.84, 95% CI: 0.76-0.93). Conversely, in non-HF population patients with LVEF improvement had higher MACCE occurrence than patients with stable LVEF and lower than deteriorating LVEF (6.97%/year vs. 5.72%/year vs. 14.55%/year respectively; log-rank p = 0.001 and p < 0.001).
Conclusions: Temporal increase of LVEF corresponds with improved survival in patients with HF but not among non-HF patients.
导论:心力衰竭(HF)伴射血分数改善(HFimpEF)与预后改善相关,但非HF患者左室射血分数(LVEF)升高的临床意义尚不清楚。该研究的目的是根据LVEF的时间变化来评估不同心血管疾病患者的长期预后,包括有和没有HF。方法:研究纳入31920例不同心血管疾病患者(中位年龄71岁,女性37.7%),且至少两次LVEF测量间隔≥1个月。临床参数来源于西里西亚医科大学临床病例学术库数据库。HFimpEF的定义是HF患者LVEF相对于基线值增加≥10%。终点为全因死亡率和主要心脑血管不良事件(MACCE)。结果:中位随访时间为51.5个月,LVEF测量中位2次。12 152例(38.1%)诊断为HF,其中2 843例(23.4%)发生HFimpEF。HF患者的MACCE发生率高于非HF患者(12.78%/年vs. 6.07%/年,p p = 0.199, p p = 0.001和p)。结论:LVEF的时间增加与HF患者的生存率提高相对应,但与非HF患者无关。
期刊介绍:
Frontiers? Which frontiers? Where exactly are the frontiers of cardiovascular medicine? And who should be defining these frontiers?
At Frontiers in Cardiovascular Medicine we believe it is worth being curious to foresee and explore beyond the current frontiers. In other words, we would like, through the articles published by our community journal Frontiers in Cardiovascular Medicine, to anticipate the future of cardiovascular medicine, and thus better prevent cardiovascular disorders and improve therapeutic options and outcomes of our patients.