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射血分数谱上心力衰竭的病因学及其与预后的关系

IF 10.3 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Heart failure Pub Date : 2025-06-16 DOI:10.1016/j.jchf.2025.03.037

Kristian Kozman MD , Giulia Ferrannini MD, PhD , Lina Benson MSc , Ulf Dahlström MD, PhD , Camilla Hage RN, PhD , Gianluigi Savarese MD, PhD , Bahira Shahim MD, PhD , Lars H. Lund MD, PhD

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引用次数: 0

摘要

背景心力衰竭（HF）病因学与射血分数（EF）类别之间的关系以及不同类型射血分数的病因学与预后之间的关系研究甚少。目的：本研究的目的是评估心力衰竭伴射血分数降低（HFrEF）、心力衰竭伴射血分数轻度降低（HFmrEF）和心力衰竭伴射血分数保留（HFpEF）患者的病因差异及其对预后的影响。方法纳入2010年4月至2023年12月在瑞典心力衰竭登记处登记的患者。根据HF病因（缺血性、瓣膜性、高血压、扩张型心肌病、酒精性心肌病等）和EF类型对患者进行分类。主要终点是到全因死亡和首次心衰住院的综合时间。采用Logistic多项式回归评估HF病因与EF类别之间的关系，采用Cox回归评估各EF类别内病因与预后之间的关系。结果在73769例HF患者中(53% HFrEF, 25% HFmrEF, 22% HFpEF；38%为缺血性，8%为瓣膜性，25%为高血压，29%为其他)，缺血性病因与HFrEF和HFmrEF独立相关，而高血压和瓣膜性病因与HFpEF相关。在HFrEF中，与所有其他3种病因相比，缺血性病因与主要结局相关。在HFmrEF中，高血压病因与首次HF住院相关（HR: 1.10 [95% CI: 1.03-1.19]）。在HFpEF中，瓣膜病因与首次HF住院相关（HR: 1.11 [95% CI: 1.02-1.22]）。结论HFrEF和HFmrEF以化学病因为主，而HFpEF以瓣膜和高血压病因为主。与死亡/HF住院最相关的病因是HFrEF的缺血性、HFmrEF的高血压和HFpEF的瓣膜性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Etiology of Heart Failure Across the Ejection Fraction Spectrum and Association With Prognosis

Background

The associations between heart failure (HF) etiology and ejection fraction (EF) category and the association between etiology and outcomes in different EF categories are poorly studied.

Objectives

The aim of this study was to assess differences in etiology and their impact on outcomes in patients with heart failure with reduced ejection fraction (HFrEF), heart failure with mildly reduced ejection fraction (HFmrEF), and heart failure with preserved ejection fraction (HFpEF).

Methods

Patients enrolled in SwedeHF (Swedish Heart Failure Registry) between April 2010 and December 2023 were included. Patients were categorized according to HF etiology (ischemic, valvular, hypertensive, dilated cardiomyopathy, alcoholic cardiomyopathy, and other) and EF category. The primary outcome was the composite of time to all-cause death and first HF hospitalization. Logistic multinominal regression was used to assess the association between HF etiology and EF category, and Cox regression was used to assess the association between etiology and outcome within each EF category.

Results

Among 73,769 patients with HF (53% HFrEF, 25% HFmrEF, and 22% HFpEF; 38% ischemic, 8% valvular, 25% hypertensive, and 29% other), ischemic etiology was independently associated with HFrEF and HFmrEF, while hypertensive and valvular etiologies were associated with HFpEF. In HFrEF, ischemic etiology was associated with the primary outcome in comparison with all other 3 etiologies. In HFmrEF, hypertensive etiology was associated with first HF hospitalization (HR: 1.10 [95% CI: 1.03-1.19]). In HFpEF, valvular etiology was associated with first HF hospitalization (HR: 1.11 [95% CI: 1.02-1.22]).

Conclusions

Ischemic etiology was dominant in HFrEF and HFmrEF, while valvular and hypertensive etiologies dominated in HFpEF. Etiologies most associated with death/HF hospitalization were ischemic in HFrEF, hypertensive in HFmrEF, and valvular in HFpEF.

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来源期刊

JACC. Heart failure

JACC. Heart failure CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

21.20

自引率

2.30%

发文量

164

期刊介绍： JACC: Heart Failure publishes crucial findings on the pathophysiology, diagnosis, treatment, and care of heart failure patients. The goal is to enhance understanding through timely scientific communication on disease, clinical trials, outcomes, and therapeutic advances. The Journal fosters interdisciplinary connections with neuroscience, pulmonary medicine, nephrology, electrophysiology, and surgery related to heart failure. It also covers articles on pharmacogenetics, biomarkers, and metabolomics.

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