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  • 胡小露,吕洋波,周亚峰,等.射血分数中间值心力衰竭住院患者的临床特征与预后分析[J].同济大学学报(医学版),2019,40(6):834-840.    [点击复制]
  • HU Xiao-lu,Lü Yang-bo,ZHOU Ya-feng,et al.Clinical features and prognosis in hospitalized patients of heart failure with mid-range ejection fraction[J].同济大学学报(医学版),2019,40(6):834-840.   [点击复制]
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射血分数中间值心力衰竭住院患者的临床特征与预后分析
胡小露,吕洋波,周亚峰,苏杨,徐亚伟,徐大春
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(上海市宝山区罗店医院心内科,上海 201908;同济大学附属第十人民医院心血管内科,上海 200072;苏州大学附属第一医院心内科,苏州 215006)
摘要:
目的 通过前瞻性单中心队列研究分析射血分数中间值力衰竭患者的临床特点及1年预后。方法 通过注册名为“DRAGON-HF(NCT03727828)”的临床研究,连续收集2017年7月至2018年7月在同济大学附属第十人民医院住院治疗且临床病例资料完整的心力衰竭病例570例,根据左心室射血分数(left ventricular ejection fraction, LVEF)分为3组。射血分数降低的心力衰竭(heart failure with reduced ejection fraction, HFrEF)组: LVEF<40%;射血分数中间值的心力衰竭(heart failure with mid-range ejection fraction, HFmrEF)组: LVEF40%~49%;射血分数保留的心力衰竭(heart failure with preserved ejection fraction, HFpEF)组: LVEF>50%。对3组患者的基本信息、既往相关病史、主要病因、实验室及心超检查结果、院内治疗及预后进行比较。结果 本研究入组心力衰竭患者男性361例(63%),女性209例(37%)完成随访535例,失访35例(6%)。平均随访(13±3.65)个月后,其中共有62例患者全因死亡。HFmrEF组在年龄、氨基末端型脑钠肽前体(N-terminal pro-brain natriuretic peptide, NT-proBNP)浓度、左室舒张末内径、左室收缩末内径介于HFpEF组和HFrEF组患者之间(P<0.05);在扩张性心肌病比例方面也介于HFpEF组和HFrEF组患者之间(P<0.0167)。在预后方面,3组患者死亡率均未见明显差异(P>0.05)。结论 HFmrEF组冠心病多,缺血性心肌病为主要病因;HFmrEF组人群特点与HFpEF组类似,但临床特点与HFrEF组更接近,药物治疗与HFrEF组相似;HFmrEF组多方面特征介于另2组之间,但1年预后与其它2组无明显差异。
关键词:  射血分数中间值的心力衰竭  队列研究  临床特点  预后
DOI:10.16118/j.1008-0392.2019.06.012
投稿时间:2019-09-05
基金项目:国家自然科学基金(81770397)
Clinical features and prognosis in hospitalized patients of heart failure with mid-range ejection fraction
HU Xiao-lu,Lü Yang-bo,ZHOU Ya-feng,SU Yang,XU Ya-wei,XU Da-chun
(Dept. of Cardiology, Luodian Hospital of Baoshan District, Shanghai 201908, China;Dept. of Cardiology, Tenth People’s Hospital, Tongji University School of Medicine, Shanghai 200072, China;Dept.of Cardiology, First Affiliated Hospital of Suzhou University, Suzhou 215006, China)
Abstract:
Objective To investigate the clinical features and 1-year prognosis in patients of heart failure of mid-range ejection fraction(HFmrEF). Methods Total 570 hospitalized heart failure patients were successively enrolled from a registered clinical trial(DRAGEN-HF, NCT: 03727828) during July 2017 to July 2018 and their major end-points(all-cause death, cardiac death, and heart failure re-hospitalization) were followed up. Patients were divided into 3 groups according to the left ventricular ejection fraction(LVEF): heart failure of reduced ejection fraction(HFrEF) group(LVEF<40%), HFmrEF group(LVEF≥40% and <50%) and heart failure of preserved ejection fraction(HFpEF) group(LVEF≥50%). The baseline characteristics, history, etiology, lab findings, echocar-diographic parameters, in-patient treatment, and outcome events were compared among 3 groups. Results There were 361 males and 209 females, and 35 cases(6%) were lost. After a mean follow-up period of (13±3.65) months, there were 62 all-cause deaths. HFmrEF patients showed the intermediate range of age, NT-proBNP level, the size of the left ventricle and tricuspid regurgitation, compared to other 2 groups(P<0.05). HFmrEF patients showed intermediate proportion of diastolic cardiomyopathy compared to other 2 groups(P<0.0167). There was no significant difference in 1-year survival among 3 groups(P>0.05). Conclusion The overall clinical features of HFmrEF patients fall in between the HFrEF and HFpEF groups, but the 1-year prognosis is not significantly different from other two groups.
Key words:  heart failure with mid-range ejection fraction  a cohort study  clinical characteri-stics  prognosis

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