Mortality associated with heart failure with preserved vs. reduced ejection fraction in a prospective internationalmulti-ethnic cohort study

被引：270

作者：

Lam, Carolyn S. P. ^{[1
,2
]}

Gamble, Greg D. ^{[3
]}

Ling, Lieng H. ^{[1
,2
]}

Sim, David ^{[2
]}

Leong, Kui Toh Gerard ^{[4
]}

Yeo, Poh Shuan Daniel ^{[5
]}

Ong, Hean Yee ^{[6
]}

Jaufeerally, Fazlur ^{[7
]}

Ng, Tze P. ^{[8
]}

Cameron, Vicky A. ^{[9
]}

Poppe, Katrina ^{[3
]}

Lund, Mayanna ^{[10
]}

Devlin, Gerry ^{[11
]}

Troughton, Richard ^{[9
]}

Richards, A. Mark ^{[1
,8
,9
]}

Doughty, Robert N. ^{[3
]}

机构：

[1] Natl Univ Hlth Syst, Cardiovasc Res Inst, 1E Kent Ridge Rd, Singapore 119228, Singapore

[2] Natl Univ Singapore, Natl Heart Ctr Singapore & Duke, 5 Hosp Dr, Singapore 169609, Singapore

[3] Univ Auckland, Heart Hlth Res Grp, Pk Rd, Auckland 1023, New Zealand

[4] Changi Gen Hosp, 2 Simei St 3, Singapore 529889, Singapore

[5] Tan Tock Seng Hosp, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore

[6] Khoo Teck Puat Hosp, 90 Yishun Cent, Singapore 768828, Singapore

[7] Singapore Gen Hosp, Outram Rd, Singapore 169608, Singapore

[8] Natl Univ Singapore, Yong Loo Lin Sch Med, 1E Kent Ridge Rd Singapore, Singapore 119228, Singapore

[9] Univ Otago, Christchurch Heart Inst, 2 Riccarton Ave, Christchurch 8011, New Zealand

[10] Middlemore Hosp, 100 Hosp Rd, Auckland 2025, New Zealand

[11] Waikato Hosp, Pembroke St, Hamilton 3204, New Zealand

来源：

EUROPEAN HEART JOURNAL | 2018年 / 39卷 / 20期

基金：

英国医学研究理事会;

关键词：

Heart failure; Ejection fraction; Mortality; Hospitalization; BRAIN NATRIURETIC PEPTIDE; EUROPEAN-SOCIETY; PROGNOSTIC VALUE; NT-PROBNP; DIAGNOSIS; ESC; GUIDELINES; PHENOTYPES; IRBESARTAN; OUTCOMES;

D O I：

10.1093/eurheartj/ehy005

中图分类号：

R5 [内科学];

学科分类号：

100201 [内科学];

摘要：

Aims Whether prevalence and mortality of patients with heart failure with preserved or mid-range (40-49%) ejection fraction (HFpEF and HFmREF) are similar to those of heart failure with reduced ejection fraction (HFrEF), as reported in some epidemiologic studies, remains highly controversial. We determined and compared characteristics and outcomes for patients with HFpEF, HFmREF, and HFrEF in a prospective, international, multi-ethnic population. Methods and results Prospective multi-centre longitudinal study in New Zealand (NZ) and Singapore. Patients with HF were assessed at baseline and followed over 2 years. The primary outcome was death from any cause. Secondary outcome was death and HF hospitalization. Cox proportional hazards models were used to compare outcomes for patients with HFpEF, HFmrEF, and HFrEF. Of 2039 patients enrolled, 28% had HFpEF, 13% HFmrEF, and 59% HFrEF. Compared with HFrEF, patients with HFpEF were older (62 vs. 72 years), more commonly female (17% vs. 48%), and more likely to have a history of hypertension (61% vs. 78%) but less likely to have coronary artery disease (55% vs. 41%). During 2 years of follow-up, 343 (17%) patients died. Adjusting for age, sex, and clinical risk factors, patients with HFpEF had a lower risk of death compared with those with HFrEF (hazard ratio 0.62, 95% confidence interval 0.46-0.85). Plasma (NT-proBNP) was similarly related to mortality in both HFpEF, HFmrEF, and HFrEF independent of the co-variates listed and of ejection fraction. Results were similar for the composite endpoint of death or HF and were consistent between Singapore and NZ. Conclusion These prospective multinational data showed that the prevalence of HFpEF within the HF population was lower than HFrEF. Death rate was comparable in HFpEF and HFmrEF and lower than in HFrEF. Plasma levels of NT-proBNP were independently and similarly predictive of death in the three HF phenotypes.

引用

页码：1770 / 1780

页数：11

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