射血分数保留的心力衰竭患者心外合并症负担的病理生理学和预后重要性

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CJC Open Pub Date : 2025-04-01 DOI:10.1016/j.cjco.2025.01.004

Yuki Saito MD, PhD , Tomonari Harada MD, PhD , Naoki Yuasa MD , Kazuki Kagami MD, PhD , Yuta Tani MSc , Ayami Naito MD , Fumitaka Murakami MD , Tomoaki Ishii RS , Toshimitsu Kato MD, PhD , Naoki Wada MD, PhD , Yasuo Okumura MD, PhD , Hideki Ishii MD, PhD , Masaru Obokata MD, PhD

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引用次数: 0

摘要

背景：心脏合并症在保留射血分数（HFpEF）的心力衰竭患者中非常普遍。我们研究了心外合并症对HFpEF患者心功能、运动能力和预后的病理生理影响。方法对775例患者（372例HFpEF患者和403例对照组）行运动超声心动图检查，同时进行呼气分析。我们将先前验证的meta分析全球慢性心力衰竭（MAGGIC）风险评分分为心脏、心外和人口统计学类别。心外负担定义为心外域评分≥5（中位数）。结果与对照组（n = 403）和无心外负担的HFpEF患者（n = 185）相比，有心外负担的HFpEF患者（n = 187）的利钠肽水平较高，运动能力较差。在运动时，他们的通气效率和外周氧提取也较差。Kaplan-Meier分析显示，有心外负担的HFpEF患者的全因死亡率和心衰事件恶化的综合结局风险明显高于无此负担的患者(logrank P <；0.0001)。Cox回归分析显示，心外域评分与复合事件的高风险显著相关(P <；0.0001)。相比之下，在对照组中，心外合并症负担与运动能力受损、通气效率下降、外周氧提取受损或临床结果恶化无关。结论HFpEF患者的心外合并症负担与运动能力下降、通气效率下降、外周氧气提取和利用受损、临床预后差等相关病理生理特征有关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

Pathophysiological and Prognostic Importance of an ExtraCardiac Comorbidity Burden in Patients with Heart Failure with Preserved Ejection Fraction

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Pathophysiological and Prognostic Importance of an ExtraCardiac Comorbidity Burden in Patients with Heart Failure with Preserved Ejection Fraction

Background

Extracardiac comorbidities are highly prevalent in patients with heart failure with preserved ejection fraction (HFpEF). We investigated the pathophysiological contribution of an extracardiac comorbidity burden to cardiac function, exercise capacity, and prognosis in patients with HFpEF.

Methods

A total of 775 patients (372 HFpEF patients and 403 control subjects) underwent exercise echocardiography, with simultaneous expired gas analysis. We separated the previously validated Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) risk score into cardiac, extracardiac, and demographic categories. An Extracardiac burden was defined as an extracardiac domain score ≥ 5 (median value).

Results

Compared to control subjects (n = 403) and patients with HFpEF without an extracardiac burden (n = 185), patients with HFpEF with an extracardiac burden (n = 187) had higher natriuretic peptide levels and worse exercise capacity. They also had worse ventilatory efficiency and worse peripheral O₂ extraction during exercise. Kaplan–Meier analysis revealed that HFpEF patients with an extracardiac burden had a significantly higher risk of the composite outcome of all-cause mortality and worsening HF events than did those without this burden (log-rank P < 0.0001). Cox regression analysis showed that the extracardiac domain score was significantly associated with a higher risk of the composite events (P < 0.0001). In contrast, an extracardiac comorbidity burden was not associated with impaired exercise capacity, worse ventilatory efficiency, impaired peripheral O₂ extraction, or worse clinical outcomes in control subjects.

Conclusions

An extracardiac comorbidity burden in patients with HFpEF is associated with relevant pathophysiological features characterized by impaired exercise capacity, worse ventilatory efficiency, impaired O₂ extraction and utilization in the periphery, and poor clinical outcomes.

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