保留射血分数的心力衰竭患者新发贫血及其与室性心律失常和心源性猝死的关系

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature Pub Date : 2025-09-25 DOI:10.1016/j.ijcha.2025.101812

Tomohiro Ito , Kotaro Nochioka , Takashi Noda , Takashi Shiroto , Shinichi Yamanaka , Nobuhiko Yamamoto , Hiroyuki Sato , Takahiko Chiba , Makoto Nakano , Takumi Inoue , Kai Susukita , Hiroyuki Takahama , Jun Takahashi , Satoshi Miyata , Hiroaki Shimokawa , Satoshi Yasuda

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引用次数: 0

摘要

背景：在保留射血分数（HFpEF）的心力衰竭患者中，贫血是一种常见的与不良结局相关的合并症。然而，HFpEF患者新发贫血与心源性猝死（SCD）的临床相关性尚不清楚。本研究探讨了新发贫血与室性心律失常（VAs）和SCD之间的关系。方法贫血定义为男性血红蛋白（Hb）水平为13 g/dL，女性血红蛋白（Hb）水平为12 g/dL。Hb水平高于这些阈值的患者被归类为无贫血。我们分析了来自一项多中心前瞻性观察性研究的686例基线时无贫血的症状性HFpEF（射血分数≥50%，纽约心脏协会II-IV级）患者的数据。主要终点是室性心动过速、室颤和SCD的复合。结果在1年的随访中，109例患者出现新发贫血（中位Hb为11.9 g/dL）， 577例患者未出现贫血（中位Hb为14.0 g/dL）。在9.2年的中位随访中，新发贫血患者的综合结局发生率明显更高（12.8% vs. 5.2%, P = 0.008）。在对潜在混杂因素进行校正后，新发贫血与复合结局的高风险相关（校正风险比2.20,95%置信区间1.10-4.42,P = 0.027）。新发贫血与致死性心律失常之间的关联与主要终点之前发生的心力衰竭住院或心肌梗死无关。结论HFpEF患者新发贫血与VAs和SCD风险增加显著相关，强调监测Hb水平对风险分层的重要性。注册：网址：https://www.clinicaltrials.gov；唯一标识符：NCT00418041。

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New-onset anemia and its association with ventricular arrhythmias and sudden cardiac death in patients with heart failure with preserved ejection fraction

Background

Anemia is a common comorbidity associated with adverse outcomes in patients with heart failure with preserved ejection fraction (HFpEF). However, the clinical relevance of new-onset anemia to sudden cardiac death (SCD) in patients with HFpEF remains unclear. This study investigated the association between new-onset anemia with ventricular arrhythmias (VAs) and SCD.

Methods

Anemia was defined as a hemoglobin (Hb) level of <13 g/dL in men and <12 g/dL in women. Patients with Hb levels above these thresholds were categorized as without anemia. We analyzed data of 686 patients with symptomatic HFpEF (ejection fraction ≥ 50 %, New York Heart Association class II–IV) without anemia at baseline from a multicenter prospective observational CHART-2 study. The primary endpoint was a composite of ventricular tachycardia, ventricular fibrillation, and SCD.

Results

At the 1-year follow-up, 109 patients developed new-onset anemia (median Hb, 11.9 g/dL), whereas 577 remained without anemia (median Hb, 14.0 g/dL). Over a median follow-up of 9.2 years, patients with new-onset anemia had a significantly higher incidence of composite outcomes (12.8 % vs. 5.2 %, P = 0.008). After adjusting for potential confounders, new-onset anemia was associated with an elevated risk of the composite outcome (adjusted hazard ratio 2.20, 95 % confidence interval 1.10–4.42, P = 0.027). The association between new-onset anemia and lethal arrhythmias was independent of heart failure hospitalization or myocardial infarction occurring before the primary endpoint.

Conclusions

New-onset anemia was significantly associated with an increased risk of VAs and SCD in patients with HFpEF, underscoring the importance of monitoring Hb levels for risk stratification.

Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00418041.

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来源期刊

IJC Heart and Vasculature Medicine-Cardiology and Cardiovascular Medicine

CiteScore

4.90

自引率

10.30%

发文量

216

审稿时长

56 days

期刊介绍： IJC Heart & Vasculature is an online-only, open-access journal dedicated to publishing original articles and reviews (also Editorials and Letters to the Editor) which report on structural and functional cardiovascular pathology, with an emphasis on imaging and disease pathophysiology. Articles must be authentic, educational, clinically relevant, and original in their content and scientific approach. IJC Heart & Vasculature requires the highest standards of scientific integrity in order to promote reliable, reproducible and verifiable research findings. All authors are advised to consult the Principles of Ethical Publishing in the International Journal of Cardiology before submitting a manuscript. Submission of a manuscript to this journal gives the publisher the right to publish that paper if it is accepted. Manuscripts may be edited to improve clarity and expression.