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IF 3.2 2区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

ESC Heart Failure Pub Date : 2025-03-01 DOI:10.1002/ehf2.15247

Yi-Peng Gao, Hong-Yun Liu, Xiao-Jun Bi, Jie Sun, Ying Zhu, Wei Zhou, Ya-Ting Fan, Xue-Qing Cheng, Pei-Na Huang, Ya-Ni Liu, You-Bin Deng

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引用次数: 0

摘要

目的：H2FPEF和HFA-PEFF评分对射血分数保留型心力衰竭（HF）具有预后价值。本研究旨在探讨 H2FPEF 和 HFA-PEFF 评分对肥厚型心肌病（HCM）患者进行 HF 风险分层的价值：在这项队列研究中，共纳入了 1068 名 HCM 患者。然后计算 H2FPEF 和 HFA-PEFF 评分，将患者分为低分、中分和高分组。主要终点是首次心房颤动住院和全因死亡的综合评分。594名（55.6%）患者的分类不一致。随访 3.1 ± 2.1 年后，85 例（8.0%）患者首次因心房颤动住院，62 例（5.8%）患者死亡。H2FPEF评分低、中、高组的首次心房颤动住院率和每千人年全因死亡率分别为25.0（95% 置信区间[CI]：14.5-35.4）、52.0（95% CI：41.6-62.3）和148.1（95% CI：77.7-218.5）。中低和高 HFA-PEFF 评分组的发病率分别为 19.3（95% CI：11.6-27.0）和 69.3（95% CI：56.4-82.1）。中度 H2FPEF 评分（危险比 [HR]：1.820，95% CI：1.135-2.919；P = 0.013）、高度 H2FPEF 评分（HR：3.464，95% CI：1.774-6.765；P 2FPEF 评分与高度 HFA-PEFF 评分相比，主要终点风险相同（HR：0.826，95% CI：0.636-1.072；P > 0.05）。肥胖（HR：1.958，95% CI：1.140-3.363；P = 0.015）、心房颤动（HR：1.686，95% CI：1.071-2.654；P = 0.024）、肺动脉高压（HR：1.613，95% CI：1.032-2.521；P = 0.036）的 H2FPEF 评分和形态学主要标准（HR：1.601，95% CI：1.084-2.364；P = 0.018）和功能性主要标准（HR：2.340，95% CI：1.442-3.797；P 2FPEF评分、HFA-PEFF评分和新算法的C指数分别为0.594、0.651和0.681）：结论：使用 H2FPEF 和 HFA-PEFF 评分对 HCM 患者进行分类存在不一致。这两个评分在对 HF 住院和 HCM 患者全因死亡进行风险分层时均具有预后价值。未来的研究应开发并验证一种整合两种评分的新算法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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H₂FPEF and HFA-PEFF scores for heart failure risk stratification in hypertrophic cardiomyopathy patients.

Aims: H₂FPEF and HFA-PEFF scores have demonstrated prognostic value in heart failure (HF) with preserved ejection fraction. This study aimed to explore the value of the H₂FPEF and HFA-PEFF scores for HF risk stratification in patients with hypertrophic cardiomyopathy (HCM).

Methods and results: In this cohort study, 1068 HCM patients were included. Then the H₂FPEF and HFA-PEFF scores were calculated to categorize patients into low, intermediate, and high score groups. The primary endpoint was a composite of the first HF hospitalization and all-cause death. 594 (55.6%) patients were classified discordantly. After a follow-up period of 3.1 ± 2.1 years, 85 (8.0%) patients were admitted for HF for the first time, and 62 (5.8%) patients died. Rates of first HF hospitalization and all-cause death per 1000 person-years for the low, intermediate, and high H₂FPEF score groups were 25.0 (95% confidence interval [CI]: 14.5-35.4), 52.0 (95% CI: 41.6-62.3), and 148.1 (95% CI: 77.7-218.5), respectively. For the low-intermediate and high HFA-PEFF score groups, rates were 19.3 (95% CI: 11.6-27.0) and 69.3 (95% CI: 56.4-82.1), respectively. Intermediate H₂FPEF score (hazard ratio [HR]: 1.820, 95% CI: 1.135-2.919; P = 0.013), high H₂FPEF score (HR: 3.464, 95% CI: 1.774-6.765; P < 0.001), and high HFA-PEFF score (HR: 2.414, 95% CI: 1.501-3.882; P < 0.001) were each independently associated with an increased risk of the primary endpoint. Intermediate-high H₂FPEF score demonstrated an equal risk for the primary endpoint compared to the high HFA-PEFF score (HR: 0.826, 95% CI: 0.636-1.072; P > 0.05). Obesity (HR: 1.958, 95% CI: 1.140-3.363; P = 0.015), atrial fibrillation (HR: 1.686, 95% CI: 1.071-2.654; P = 0.024), pulmonary hypertension (HR: 1.613, 95% CI: 1.032-2.521; P = 0.036) of the H₂FPEF score, and the morphological major criterion (HR: 1.601, 95% CI: 1.084-2.364; P = 0.018) and functional major criterion (HR: 2.340, 95% CI: 1.442-3.797; P < 0.001) of the HFA-PEFF score were independent predictors of the primary endpoint. A new algorithm was constructed using the independent predictors from both scores, with the functional major criterion weighted as 2 points and the others as 1 point. The H₂FPEF score, HFA-PEFF score, and the new algorithm demonstrated C-indices of 0.594, 0.651, and 0.681, respectively.

Conclusions: There is discordance in the classification of patients with HCM using the H₂FPEF and HFA-PEFF scores. Both scores demonstrated prognostic value in risk stratification for HF hospitalization and all-cause death in HCM patients. Future studies should develop and validate a new algorithm integrating both scores.

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来源期刊

ESC Heart Failure Medicine-Cardiology and Cardiovascular Medicine

CiteScore

7.00

自引率

7.90%

发文量

461

审稿时长

12 weeks

期刊介绍： ESC Heart Failure is the open access journal of the Heart Failure Association of the European Society of Cardiology dedicated to the advancement of knowledge in the field of heart failure. The journal aims to improve the understanding, prevention, investigation and treatment of heart failure. Molecular and cellular biology, pathology, physiology, electrophysiology, pharmacology, as well as the clinical, social and population sciences all form part of the discipline that is heart failure. Accordingly, submission of manuscripts on basic, translational, clinical and population sciences is invited. Original contributions on nursing, care of the elderly, primary care, health economics and other specialist fields related to heart failure are also welcome, as are case reports that highlight interesting aspects of heart failure care and treatment.