射血分数
医学
心力衰竭
心脏病学
内科学
危险系数
临床终点
比例危险模型
利钠肽
射血分数保留的心力衰竭
置信区间
随机对照试验
作者
Yu Horiuchi,Masahiko Asami,Tomomi Ide,Kazuyuki Yahagi,Kanki Komiyama,Hitomi Yuzawa,Jun Tanaka,Jiro Aoki,Shouji Matsushima,Takeshi Tohyama,Nobuyuki Enzan,Hiroyuki Tsutsui,Kazuaki Tanabe
摘要
Abstract Aims We aimed to investigate the characteristics and prognosis of patients with heart failure (HF) with supra‐normal ejection fraction (HFsnEF) compared to HF with normal ejection fraction (HFnEF). Methods and results Among 11 573 patients enrolled in the nationwide registry of hospitalized patients with HF in Japan, 1943 patients (16.8%) were classified as HFsnEF (left ventricular ejection fraction [LVEF] >65%), 3277 (28.3%) as HFnEF (50% ≤ LVEF ≤65%), 2024 (17.5%) as HF with mildly reduced ejection fraction (40% ≤ LVEF <50%) and 4329 (37.4%) as HF with reduced ejection fraction (LVEF <40%). Patients with HFsnEF were older, more likely to be women, had lower natriuretic peptide values, and had smaller left ventricles than those with HFnEF. The primary endpoint, the composite of cardiovascular death or HF readmission, did not differ between HFsnEF (802/1943, 41.3%) and HFnEF (1413/3277, 43.1%) during a median follow‐up period of 870 days (hazard ratio [HR] 0.96, 95% confidence interval 0.88–1.05, p = 0.346). The incidence of secondary outcomes, including all‐cause, cardiovascular, and non‐cardiovascular deaths and HF readmission, did not differ between HFsnEF and HFnEF. In the multivariable Cox regression analysis, HFsnEF compared to HFnEF was associated with a lower adjusted HR for HF readmission but not with the primary and other secondary endpoints. HFsnEF was associated with a higher HR for the composite endpoint and all‐cause death in women, and a higher HR for all‐cause death in patients with renal dysfunction. Conclusions Heart failure with supra‐normal ejection fraction is a common and distinctive phenotype, and has different characteristics and prognoses from HFnEF.
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