■射血分数改善的心力衰竭(HFrEF)患者的预后比持续降低的患者更好。本研究旨在分析HFrEF患者进展为射血分数改善的心力衰竭(HFimpEF)的预测因素。以及它们的特点,并分析预后的预测因素。
■对1251例基线HFrEF患者进行了回顾性分析,也有第二次超声心动图≥3个月。左心室射血分数(LVEF)重新评估后,患者分为HFimpEF组(n=408)和持续性HFrEF组(n=611).主要终点是心血管死亡或心力衰竭住院的复合终点。
■多变量逻辑回归显示,没有饮酒史(OR:0.47,95%CI:0.28-0.78),非纽约心脏协会(NYHA)III-IV级(OR:0.28,95%CI:0.15-0.52),无扩张型心肌病(OR:0.47,95%CI:0.26-0.84),合并高血压(OR:1.53,95%CI:1.02-2.29),β受体阻滞剂的使用(OR:2.29,95%CI:1.54-3.43),和较低的尿酸(OR:0.999,95%CI:0.997-1.000)可以预测LVEF的改善。Kaplan-Meier曲线显示HFimpEF患者的不良事件发生率显著低于HFrEF患者(log秩p<0.001)。多因素Cox回归发现年龄较大(HR:1.04,95%CI:1.02-1.06),NYHAIII-IV级(HR:2.25,95%CI:1.28-3.95),合并心脏瓣膜病(HR:1.98,95%CI:1.01-3.85),和较高的肌酐(HR:1.003,95%CI:1.001-1.004)是HFimpEF患者主要终点的独立危险因素。
■无饮酒史的HFrEF患者,非NYHAIII-IV级,没有扩张型心肌病,伴随高血压,β-受体阻滞剂的使用,较低的尿酸水平更有可能改善LVEF。尽管HFimpEF患者的预后优于HFrEF患者,年龄较大,NYHAIII-IV级,伴随心脏瓣膜病,高肌酐仍是HFimpEF患者心血管事件的危险因素.
UNASSIGNED: Heart failure with reduced ejection fraction (HFrEF) patients who have improved ejection fraction have a better prognosis than those with persistently reduced ejection fraction. This study aimed to analyze the predictors for progression of patients with HFrEF to heart failure with improved ejection fraction (HFimpEF), as well as their characteristics and analyze predictors for prognosis.
UNASSIGNED: A retrospective analysis was conducted on 1251 patients with HFrEF at baseline, who also had a second echocardiogram ≥ 3 months. After left ventricular ejection fraction (LVEF) reassessment, patients were separated into the HFimpEF group (n = 408) and the persistent HFrEF group (n = 611). The primary endpoint was a composite of cardiovascular death or heart failure hospitalization.
UNASSIGNED: Multivariate logistic regression showed that without history of alcohol consumption (OR: 0.47, 95% CI: 0.28-0.78), non-New York Heart Association (NYHA) class III-IV (OR: 0.28, 95% CI: 0.15-0.52), without dilated cardiomyopathy (OR: 0.47, 95% CI: 0.26-0.84), concomitant hypertension (OR: 1.53, 95% CI: 1.02-2.29), β -blockers use (OR: 2.29, 95% CI: 1.54-3.43), and lower uric acid (OR: 0.999, 95% CI: 0.997-1.000) could predict LVEF improvement. Kaplan-Meier curves demonstrated that HFimpEF patients had a significantly lower incidence of adverse events than HFrEF patients (log Rank p < 0.001). Multivariate Cox regression found that older age (HR: 1.04, 95% CI: 1.02-1.06), NYHA class III-IV (HR: 2.25, 95% CI: 1.28-3.95), concomitant valvular heart disease (HR: 1.98, 95% CI: 1.01-3.85), and higher creatinine (HR: 1.003, 95% CI: 1.001-1.004) were independent risk factors for the primary endpoint in HFimpEF patients.
UNASSIGNED: HFrEF patients without a history of alcohol consumption, non-NYHA class III-IV, without dilated cardiomyopathy, concomitant hypertension, β -blockers use, and lower uric acid were more likely to have LVEF improvement. Although the prognosis of HFimpEF patients was better than that of HFrEF patients, older age, NYHA class III-IV, concomitant valvular heart disease, and higher creatinine were still risk factors for cardiovascular events in HFimpEF patients.