Predictors and outcomes of heart failure with mid-range ejection fraction

被引：159

作者：

Bhambhani, Vijeta ^{[1
,2
]}

Kizer, Jorge R. ^{[3
,4
]}

Lima, Joao A. C. ^{[5
]}

van der Harst, Pim ^{[6
]}

Bahrami, Hossein ^{[7
]}

Nayor, Matthew ^{[2
]}

de Filippi, Christopher R. ^{[8
]}

Enserro, Danielle ^{[9
]}

Blaha, Michael J. ^{[10
]}

Cushman, Mary

Wang, Thomas J. ^{[11
]}

Gansevoort, Ron T. ^{[12
]}

Fox, Caroline S. ^{[13
]}

Gaggin, Hanna K. ^{[2
]}

Kop, Willem J. ^{[14
]}

Liu, Kiang

Vasan, Ramachandran S. ^{[16
]}

Psaty, Bruce M. ^{[17
,18
,19
]}

Lee, Douglas S. ^{[20
]}

Brouwers, Frank P. ^{[6
]}

Hillege, Hans L. ^{[6
]}

Bartz, Traci M. ^{[21
]}

Benjamin, Emelia J. ^{[16
]}

Chan, Cheeling ^{[15
]}

Allison, Matthew ^{[22
]}

Gardin, Julius M. ^{[23
]}

Januzzi, James L., Jr. ^{[2
]}

Levy, Daniel ^{[13
,24
]}

Herrington, David M. ^{[25
]}

van Gilst, Wiek H. ^{[6
]}

Bertoni, Alain G. ^{[26
]}

Larson, Martin G. ^{[13
,27
]}

de Boer, Rudolf A. ^{[6
]}

Gottdiener, John S. ^{[28
]}

Shah, Sanjiv J. ^{[29
]}

Ho, Jennifer E. ^{[1
,2
]}

机构：

[1] Massachusetts Gen Hosp, Cardiovasc Res Ctr, Boston, MA 02114 USA

[2] Massachusetts Gen Hosp, Dept Med, Cardiol Div, Boston, MA 02114 USA

[3] Albert Einstein Coll Med, Dept Med, Bronx, NY 10467 USA

[4] Albert Einstein Coll Med, Dept Epidemiol & Populat Hlth, Bronx, NY 10467 USA

[5] Johns Hopkins Med Inst, Heart & Vasc Inst, Dept Med & Cardiol, Baltimore, MD 21205 USA

[6] Univ Groningen, Univ Med Ctr Groningen, Dept Cardiol, Groningen, Netherlands

[7] Univ Southern Calif, Keck Sch Med, Div Cardiovasc Med, Los Angeles, CA 90033 USA

[8] Inova Heart & Vasc Inst, Falls Church, VA USA

[9] Boston Univ, Sch Med, Dept Prevent Med, Boston, MA 02118 USA

[10] Johns Hopkins Univ, Ciccarone Ctr Prevent Heart Dis, Baltimore, MD USA

[11] Vanderbilt Univ, Med Ctr, Divis Cardiovasc Med, 221 Kirkland Hall, Nashville, TN 37235 USA

[12] Univ Groningen, Univ Med Ctr, Dept Internal Med, Groningen, Netherlands

[13] Framingham Heart Dis Epidemiol Study, Framingham, MA USA

[14] Tilburg Univ, Dept Med & Clin Psychol, Ctr Res Psychol Somat Dis, Tilburg, Netherlands

[15] Northwestern Univ, Feinberg Sch Med, Dept Prevent Med, Chicago, IL 60611 USA

[16] Boston Univ, Sch Med, Dept Med, Cardiovasc Med Sect, Boston, MA 02118 USA

[17] Univ Washington, Dept Med, Cardiovasc Hlth Res Unit, Seattle, WA 98195 USA

[18] Univ Washington, Dept Epidemiol & Hlth Serv, Cardiovasc Hlth Res Unit, Seattle, WA 98195 USA

[19] Kaiser Permanente Washington Hlth Res Inst, Seattle, WA USA

[20] Inst Clin Evaluat Sci, Toronto, ON, Canada

[21] Univ Washington, Dept Biostat, Seattle, WA 98195 USA

[22] Univ Calif San Diego, Dept Family Med & Publ Hlth, La Jolla, CA 92093 USA

[23] Rutgers New Jersey Med Sch, Dept Med, Div Cardiol, Newark, NJ USA

[24] NHLBI, Populat Sci Branch, NIH, Bldg 10, Bethesda, MD 20892 USA

[25] Wake Forest Sch Med, Sect Cardiovasc Med, Winston Salem, NC USA

[26] Wake Forest Sch Med, Div Publ Hlth Sci, Dept Epidemiol & Prevent, Winston Salem, NC USA

[27] Boston Univ, Dept Math & Stat, Boston, MA 02215 USA

[28] Univ Maryland, Dept Med, Div Cardiol, Baltimore, MD 21201 USA

[29] Northwestern Univ, Feinberg Sch Med, Dept Med, Div Cardiol, Chicago, IL 60611 USA

来源：

EUROPEAN JOURNAL OF HEART FAILURE | 2018年 / 20卷 / 04期

关键词：

Heart failure; Risk factor; Ejection fraction;

D O I：

10.1002/ejhf.1091

中图分类号：

R5 [内科学];

学科分类号：

100201 [内科学];

摘要：

Aims While heart failure with preserved (HFpEF) and reduced ejection fraction (HFrEF) are well described, determinants and outcomes of heart failure with mid-range ejection fraction (HFmrEF) remain unclear. We sought to examine clinical and biochemical predictors of incident HFmrEF in the community. Methods and results We pooled data from four community-based longitudinal cohorts, with ascertainment of new heart failure (HF) classified into HFmrEF [ejection fraction (EF) 41-49%], HFpEF (EF >= 50%), and HFrEF (EF <= 40%). Predictors of incident HF subtypes were assessed using multivariable Cox models. Among 28 820 participants free of HF followed for a median of 12 years, there were 200 new HFmrEF cases, compared with 811 HFpEF and 1048 HFrEF. Clinical predictors of HFmrEF included age, male sex, systolic blood pressure, diabetes mellitus, and prior myocardial infarction (multivariable adjusted P = 0.003 for all). Biomarkers that predicted HFmrEF included natriuretic peptides, cystatin-C, and high-sensitivity troponin (P = 0.0004 for all). Natriuretic peptides were stronger predictors of HFrEF [hazard ratio (HR) 2.00 per 1 standard deviation increase, 95% confidence interval (CI) 1.81-2.20] than of HFmrEF (HR 1.51, 95% CI 1.20-1.90, P = 0.01 for difference), and did not differ in their association with incident HFmrEF and HFpEF (HR 1.56, 95% CI 1.41-1.73, P = 0.68 for difference). All-cause mortality following the onset of HFmrEF was worse than that of HFpEF (50 vs. 39 events per 1000 person-years, P = 0.02), but comparable to that of HFrEF (46 events per 1000 person-years, P = 0.78). Conclusions We found overlap in predictors of incident HFmrEF with other HF subtypes. In contrast, mortality risk after HFmrEF was worse than HFpEF, and similar to HFrEF.

引用

页码：651 / 659

页数：9

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