SPRINT 中射血分数保留与射血分数降低的急性心力衰竭的发生率和结果,Circulation: Heart Failure

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SPRINT 中射血分数保留与射血分数降低的急性心力衰竭的发生率和结果
Circulation: Heart Failure ( IF 7.8 ) Pub Date : 2021-11-26 , DOI: 10.1161/circheartfailure.121.008322
Bharathi Upadhya ₁ , James J Willard ₂ , Laura C Lovato ₂ , Michael V Rocco ₃ , Cora E Lewis ₄ , Suzanne Oparil ₅ , William C Cushman _{5,

6} , Jeffrey T Bates ₇ , Natalie A Bello ₈ , Gerard Aurigemma ₉ , Karen C Johnson ₁₀ , Carlos J Rodriguez ₁₁ , Dominic S Raj ₁₂ , Anjay Rastogi ₁₃ , Leonardo Tamariz _{14,

15} , Alan Wiggers ₁₆ , Dalane W Kitzman ₁ ,

Affiliation

Cardiovascular Medicine Section (B.U., D.W.K.), Wake Forest School of Medicine, Winston-Salem, NC.
Biostatistics (J.J.W., L.C.L.), Wake Forest School of Medicine, Winston-Salem, NC.
Nephrology Section, Department of Internal Medicine (M.V.R.), Wake Forest School of Medicine, Winston-Salem, NC.
Department of Epidemiology, School of Public Health (C.E.L.), University of Alabama at Birmingham.
Division of Cardiovascular Disease, Department of Medicine (S.O.), University of Alabama at Birmingham.
Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (W.C.C.).
Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX (J.T.B.).
Cardiovascular Division, Department of Medicine, Columbia University Medical Center, New York, NY (N.A.B.).
Cardiology, University of Massachusetts Medical School, Worcester (G.A.).
Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (K.C.J.).
Department of Medicine, Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY (C.J.R.).
Medicine-Nephrology, George Washington University School of Medicine, Washington, DC (D.S.R.).
Division of Nephrology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (A.R.).
University of Miami Miller School of Medicine, FL (L.T.).
Veterans Affairs Medical Center, Miami, FL (L.T.).
University Hospitals Harrington Heart and Vascular Institute, Cleveland Medical Center, OH (A.W.).

背景：在 SPRINT（收缩压干预试验）中，强化 BP 治疗减少了急性失代偿性心力衰竭 (ADHF) 事件。在这里，我们报告了对射血分数保留的心衰 (HFpEF) 和射血分数降低的心衰 (HFrEF) 的影响及其后续结果。委员会使用标准化协议。HFpEF 定义为 EF ≥45%，HFrEF 定义为 EF <45%。结果：在接受 EF 评估的 133 名患有 ADHF 事件的参与者中，69 名 (52%) 患有 HFpEF，64 名 (48%) 患有 HFrEF ( P值：0.73）。在对发生 ADHF 事件的患者进行平均 3.3 年的随访期间，随后的全因和 HF 再入院率和死亡率很高，但发生 HFpEF 与 HFrEF 的患者之间没有显着差异。无论 EF 亚型如何，随机分配到强化组对初始 ADHF 事件后的后续死亡率或再入院率没有影响。在对发生 HFpEF 的参与者进行随访期间，虽然相对较少的事件数量限制了统计功效，但年龄是全因死亡率的独立预测因子，黑人种族独立预测全因和 HF 医院再入院。结论：在 SPRINT 中，强化降压可减少急性失代偿性 HFpEF 和 HFrEF 事件。在最初的 ADHF 事件后，随后的住院率和死亡率很高，并且对于发生 HFpEF 或 HFrEF 的患者而言相似。随机分配到强化组并没有改变 HFpEF 或 HFrEF 中后续全因或 HF 事件的风险。在发生 HFpEF 的人群中，年龄和黑人种族是临床结果的独立预测因素。注册：URL：https://www.clinicaltrials.gov；唯一标识符：NCT01206062。

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Incidence and Outcomes of Acute Heart Failure With Preserved Versus Reduced Ejection Fraction in SPRINT

Background:In the SPRINT (Systolic Blood Pressure Intervention Trial), intensive BP treatment reduced acute decompensated heart failure (ADHF) events. Here, we report the effect on HF with preserved ejection fraction (HFpEF) and HF with reduced EF (HFrEF) and their subsequent outcomes.Methods:Incident ADHF was defined as hospitalization or emergency department visit, confirmed, and formally adjudicated by a blinded events committee using standardized protocols. HFpEF was defined as EF ≥45%, and HFrEF was EF <45%.Results:Among the 133 participants with incident ADHF who had EF assessment, 69 (52%) had HFpEF and 64 (48%) had HFrEF (P value: 0.73). During average 3.3 years follow-up in those who developed incident ADHF, rates of subsequent all-cause and HF hospital readmission and mortality were high, but there were no significant differences between those who developed HFpEF versus HFrEF. Randomization to the intensive arm had no effect on subsequent mortality or readmissions after the initial ADHF event, irrespective of EF subtype. During follow-up among participants who developed HFpEF, although relatively modest number of events limited statistical power, age was an independent predictor of all-cause mortality, and Black race independently predicted all-cause and HF hospital readmission.Conclusions:In SPRINT, intensive BP reduction decreased both acute decompensated HFpEF and HFrEF events. After initial incident ADHF, rates of subsequent hospital admission and mortality were high and were similar for those who developed HFpEF or HFrEF. Randomization to the intensive arm did not alter the risks for subsequent all-cause, or HF events in either HFpEF or HFrEF. Among those who developed HFpEF, age and Black race were independent predictors of clinical outcomes.Registration:URL: https://www.clinicaltrials.gov; Unique identifier: NCT01206062.

更新日期：2021-12-22

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