■我们对LVEF改善和EF改善的心力衰竭(HFimpEF)表型相关因素的理解仍然不完整。
■我们使用退伍军人事务(VA)卫生系统随访患者的国家数据库进行了一项回顾性研究,并通过超声心动图对左心室射血分数(LVEF)进行了连续评估。我们确定了美国退伍军人与心力衰竭的新诊断:(i)LVEF<40%在诊断前的12个月,和(ii)诊断后至少6个月随访LVEF评估。我们将HFimpEF定义为最终LVEF≥40%。
■在本分析中,在初始LVEF<40%的106,414名美国退伍军人中,中位随访5年后,39,994(37.6%)的最终EF>40%。多因素回归分析确定了与LVEF改善独立相关的几个因素,包括女性,年龄较小,BMI较高,以及高血压等特定合并症的病史,瓣膜疾病,心房颤动,结缔组织病,肝病,和恶性肿瘤(p<0.001)。相反,缺血性心脏病和外周动脉疾病的病史,以及特定的种族背景(黑人和西班牙裔)与较低的LVEF改善率相关.预测LVEF改善的模型c统计量为0.70。
■这么大,详细的数据集有助于分析大量与HFimpEF显著相关的变量;然而,他们对LVEF改善的综合歧视价值仍然不大,强调控制LV功能的基因-环境-治疗相互作用的复杂性。
UNASSIGNED: Our understanding of the factors associated with improvement of LVEF and a heart failure with improved EF (HFimpEF) phenotype remains incomplete.
UNASSIGNED: We conducted a retrospective study using a national database of patients followed in the Veterans Affairs (VA) health system with serial assessment of left ventricular ejection fraction (LVEF) by echocardiography. We identified US veterans with a new diagnosis of heart failure with: (i) LVEF of <40 % in the 12 months prior to diagnosis, and (ii) follow-up LVEF assessment at least 6 months after their diagnosis. We defined HFimpEF as a final LVEF of ≥40 %.
UNASSIGNED: Among the 106,414 US veterans with an initial LVEF of <40 % in this analysis, 39,994 (37.6 %) had a final EF of >40 % after a median follow up of 5 years. Multivariate regression analysis identified several factors that were independently associated with LVEF improvement including female sex, younger age, higher BMI, and a history of specific comorbid conditions such as hypertension, valve disease, atrial fibrillation, connective tissue disease, liver disease, and malignancy (p < 0.001). Conversely, a history of ischemic heart disease and peripheral arterial disease, as well as specific racial backgrounds (Black and Hispanic) were associated with lower rates of LVEF improvement. The model c-statistic for predicting LVEF improvement was 0.70.
UNASSIGNED: This large, detailed dataset facilitated an analysis of a large number of variables that significantly associated with HFimpEF; however, their combined discriminatory value for LVEF improvement remained modest, underscoring the complexity of the gene-environment-treatment interactions that govern LV function.