射血分数保留和预后不良心力衰竭门诊患者的表型分析

Q3 Medicine

Russian Journal of Cardiology Pub Date : 2024-04-18 DOI:10.15829/1560-4071-2024-5759

V. Larina, V. I. Lunev

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引用次数: 0

摘要

通过超声心动图测定的左心室整体功能指数（LVGFI）及其导数是否适用于区分射血分数保留型心力衰竭（HFpEF）患者队列中的临床表型尚不清楚。评估 LVGFI 及其衍生物在对年龄≥60 岁的门诊 HFpEF 患者进行表型分析时的鉴别诊断潜力。研究共纳入 140 名门诊患者（男性，43%），年龄为 73（67-78）岁，功能分级为 II-IV 级 HFpEF。随访时间为 34（22-36）个月。LVGFI为22.4（19.4-24.6）%，而LVGFI的导数指数为283.9（248.9-332.2）毫升。死亡人数为 18 人（12.9%）。LVGFI 预测死亡的临界值≤21.4%，而 LVGFI 的导数指数 - ≥303.6 毫升。根据集群成员资格和死亡率分析，确定了以下两个高频心衰患者死亡风险组：相对低风险组（第 1 组）和中度风险组（第 2 组）（34 个月内死亡率约为 25%）。第 1 组主要由男性患者组成，他们患有 II 级 HFpEF、冠状动脉疾病（CAD）和既往心肌梗死（MI）、同心度肥大、左心室质量显著增加、呼吸弯曲频率高、左心室总指数（LVGFI）较低和左心室总指数（LVGFI）的导数指数较高。第 2 组患者主要为女性，HF 为 II 级，有 CAD 和心肌梗死病史，存在同心性肥厚和同心性重塑，左心室质量中度增加，呼吸弯曲频率相对较低，LVGFI 较高，LVGFI 的导数指数较低。根据所获得的数据，开发了一种算法，用于确定高频心衰患者的死亡风险。结论：LVGFI及其导数指数可用于HFpEF患者的表型分析。所开发的确定死亡风险的算法可以确定哪些门诊高频低氧血症患者需要全科医生和心脏病专家加强治疗和观察，以降低预后不良的风险。

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Phenotyping of outpatients with heart failure with preserved ejection fraction and poor prognosis

The applicability of the left ventricular global function index (LVGFI) and its derivative, determined by echocardiography, to distinguish clinical phenotypes in a cohort of patients with heart failure with preserved ejection fraction (HFpEF) is unknown.Aim. To evaluate the differential diagnostic potential of LVGFI and its derivative when phenotyping outpatients aged ≥60 years with HFpEF.Material and methods. A total of 140 outpatients (men, 43%) aged 73 (67-78) years with functional class II-IV HFpEF were included in the study. The follow-up period was 34 (22-36) months.Results. LVGFI was 22,4 (19,4-24,6)%, while derivative index of LVGFI — 283,9 (248,9-332,2) ml. There were 18 (12,9%) deaths. The threshold value for predicting death for LVGFI was ≤21,4%, for derivative index of LVGFI — ≥303,6 ml. Based on cluster membership and mortality analysis, two following risk groups for death of patients with HFpEF were identified: a relatively low-risk (group 1) and moderate (group 2) risk group (mortality within 34 months ~25%). Group 1 was represented by patients, predominantly male, with class II HFpEF, coronary artery disease (CAD) and prior myocardial infarction (MI), concentric hypertrophy, a significant LV mass increase, a high frequency of bendopnea, lower LVGFI and higher derivative index of LVGFI. Group 2 was represented by patients, predominantly female, with class II HF, a history of CAD and myocardial infarction, concentric hypertrophy and concentric remodeling, a moderate LV mass increase, a relatively low frequency of bendopnea, higher LVGFI and lower derivative index of LVGFI. Based on the data obtained, an algorithm was developed to determine the risk of death in patients with HFpEF.Conclusion. LVGFI and its derivative index can be used in phenotyping patients with HFpEF. The developed algorithm for determining the death risk makes it possible to identify outpatients with HFpEF who need intensified therapy and observation by a general practitioner and cardiologist in order to reduce the risk of an unfavorable prognosis.

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来源期刊

Russian Journal of Cardiology Medicine-Cardiology and Cardiovascular Medicine

CiteScore

2.20

自引率

0.00%

发文量

185

审稿时长

1 months

期刊介绍： Russian Journal of Cardiology has been issued since 1996. The language of this publication is Russian, with tables of contents and abstracts of all articles presented in English as well. Editor-in-Chief: Prof. Eugene V.Shlyakhto, President of the Russian Society of Cardiology. The aim of the journal is both scientific and practical, also with referring to organizing matters of the Society. The best of all cardiologic research in Russia is submitted to the Journal. Moreover, it contains useful tips and clinical examples for practicing cardiologists. Journal is peer-reviewed, with multi-stage editing. The editorial board is presented by the leading cardiologists from different cities of Russia.