射血分数保留的心力衰竭患者的年龄相关特征和预后,Journal of the American College of Cardiology

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射血分数保留的心力衰竭患者的年龄相关特征和预后
Journal of the American College of Cardiology ( IF 21.7 ) Pub Date : 2019-08-01 , DOI: 10.1016/j.jacc.2019.05.052
Jasper Tromp ₁ , Li Shen ₂ , Pardeep S Jhund ₂ , Inder S Anand ₃ , Peter E Carson ₄ , Akshay S Desai ₅ , Christopher B Granger ₆ , Michel Komajda ₇ , Robert S McKelvie ₈ , Marc A Pfeffer ₅ , Scott D Solomon ₅ , Lars Køber ₉ , Karl Swedberg ₁₀ , Michael R Zile ₁₁ , Bertram Pitt ₁₂ , Carolyn S P Lam ₁ , John J V McMurray ₂

Affiliation

National Heart Centre Singapore and Duke-NUS Medical School, Singapore; Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands.
BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom.
Department of Medicine, University of Minnesota Medical School and VA Medical Center, Minneapolis, Minnesota.
Department of Cardiology, Washington VA Medical Center, Washington, DC.
Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Duke Clinical Research Institute, Duke University, Durham, North Carolina.
Department of Cardiology, Hospital Saint Joseph, Paris, France.
Western University, London, Ontario, Canada.
Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg and National Heart and Lung Institute, Imperial College, London, United Kingdom.
Medical University of South Carolina and Ralph H. Johnston Veterans Administration Medical Center, Charleston, South Carolina.
Department of Internal Medicine-Cardiology, University of Michigan School of Medicine, Ann Arbor, Michigan.

背景虽然射血分数保留的心力衰竭 (HFpEF) 被认为是老年人的疾病，但年轻患者也不能幸免于这种综合征。目的因此，本研究调查了 HFpEF 患者的年龄、临床特征和结果之间的关联。方法使用来自 3 项大型 HFpEF 试验（TOPCAT [醛固酮拮抗剂治疗心力衰竭和收缩功能保留的成人]、I-PRESERVE [厄贝沙坦治疗收缩功能保留的心力衰竭] 和CHARM Preserved [坎地沙坦酯在降低死亡率和发病率的心力衰竭评估中]），患者根据年龄分类：≤55 岁（n = 522）、56 至 64 岁（n = 1,679）、65 至 74 岁（n = 3,405），75 至 84 岁（n = 2,464），并且≥85 岁（n = 398）。本研究比较了临床和超声心动图特征、死亡率和住院率、死亡模式和不同年龄段的生活质量。结果年轻的 HFpEF 患者（年龄 ≤ 55 岁）更多是肥胖的非白人男性，而老年 HFpEF 患者更多是白人女性，房颤、高血压和慢性肾病（eGFR <60 ml/min）的患病率更高/1.73 平方米）。尽管合并症较少，但与老年患者（年龄≥85 岁）相比，年轻患者的生活质量较差。与≤ 55 岁的患者相比，≥ 85 岁的患者死亡率更高（风险比：6.9；95% 置信区间：4.2 至 11.4）。然而，在死亡患者中，猝死按比例是最常见的死亡方式（p < 0. 001) 患者年龄≤55 岁。相比之下，老年患者（年龄≥85 岁）死于非心血管原因的频率更高（年龄≤55 岁的患者为 34% 与 20%；p < 0.001）。结论与老年人相比，年轻的 HFpEF 患者白人的可能性较小，男性肥胖的频率更高，死于心血管原因的频率更高，尤其是猝死。相比之下，老年 HFpEF 患者有更多的合并症，死于非心血管原因的频率更高。（醛固酮拮抗剂治疗心力衰竭和收缩功能保留的成人 [TOPCAT]；NCT00094302；厄贝沙坦治疗收缩功能保留的心力衰竭 [I-PRESERVE]；NCT00095238；坎地沙坦在心力衰竭评估和降低死亡率中的应用]; NCT00634712)。老年患者（年龄≥85 岁）死于非心血管原因的频率更高（34% 对 55 岁以下患者的 20%；p < 0.001）。结论与老年人相比，年轻的 HFpEF 患者白人的可能性较小，男性肥胖的频率更高，死于心血管原因的频率更高，尤其是猝死。相比之下，老年 HFpEF 患者有更多的合并症，死于非心血管原因的频率更高。（醛固酮拮抗剂治疗心力衰竭和收缩功能保留的成人 [TOPCAT]；NCT00094302；厄贝沙坦在收缩功能保留的心力衰竭中 [I-PRESERVE]；NCT00095238；坎地沙坦在心力衰竭评估和死亡率降低中的应用 [PRESERVE] ]; NCT00634712)。老年患者（年龄≥85 岁）死于非心血管原因的频率更高（34% 对 55 岁以下患者的 20%；p < 0.001）。结论与老年人相比，年轻的 HFpEF 患者白人的可能性较小，男性肥胖的频率更高，死于心血管原因的频率更高，尤其是猝死。相比之下，老年 HFpEF 患者有更多的合并症，死于非心血管原因的频率更高。（醛固酮拮抗剂治疗心力衰竭和收缩功能保留的成人 [TOPCAT]；NCT00094302；厄贝沙坦治疗收缩功能保留的心力衰竭 [I-PRESERVE]；NCT00095238；坎地沙坦在心力衰竭评估和降低死亡率中的应用]; NCT00634712)。≤ 55 岁患者 20%；p < 0.001)。结论与老年人相比，年轻的 HFpEF 患者白人的可能性较小，男性肥胖的频率更高，死于心血管原因的频率更高，尤其是猝死。相比之下，老年 HFpEF 患者有更多的合并症，死于非心血管原因的频率更高。（醛固酮拮抗剂治疗心力衰竭和收缩功能保留的成人 [TOPCAT]；NCT00094302；厄贝沙坦治疗收缩功能保留的心力衰竭 [I-PRESERVE]；NCT00095238；坎地沙坦在心力衰竭评估和降低死亡率中的应用]; NCT00634712)。≤ 55 岁患者 20%；p < 0.001)。结论与老年人相比，年轻的 HFpEF 患者白人的可能性较小，男性肥胖的频率更高，死于心血管原因的频率更高，尤其是猝死。相比之下，HFpEF 老年患者有更多的合并症，死于非心血管原因的频率更高。（醛固酮拮抗剂治疗心力衰竭和收缩功能保留的成人 [TOPCAT]；NCT00094302；厄贝沙坦治疗收缩功能保留的心力衰竭 [I-PRESERVE]；NCT00095238；坎地沙坦在心力衰竭评估和降低死亡率中的应用]; NCT00634712)。并且更常死于心血管原因，尤其是猝死。相比之下，老年 HFpEF 患者有更多的合并症，死于非心血管原因的频率更高。（醛固酮拮抗剂治疗心力衰竭和收缩功能保留的成人 [TOPCAT]；NCT00094302；厄贝沙坦治疗收缩功能保留的心力衰竭 [I-PRESERVE]；NCT00095238；坎地沙坦在心力衰竭评估和降低死亡率中的应用]; NCT00634712)。并且更常死于心血管原因，尤其是猝死。相比之下，HFpEF 老年患者有更多的合并症，死于非心血管原因的频率更高。（醛固酮拮抗剂治疗心力衰竭和收缩功能保留的成人 [TOPCAT]；NCT00094302；厄贝沙坦治疗收缩功能保留的心力衰竭 [I-PRESERVE]；NCT00095238；坎地沙坦在心力衰竭评估和降低死亡率中的应用]; NCT00634712)。厄贝沙坦治疗心力衰竭并保留收缩功能 [I-PRESERVE]；NCT00095238; 坎地沙坦酯在降低死亡率和发病率的心力衰竭评估中 [CHARM Preserved]；NCT00634712）。厄贝沙坦治疗心力衰竭并保留收缩功能 [I-PRESERVE]；NCT00095238; 坎地沙坦酯在降低死亡率和发病率的心力衰竭评估中 [CHARM Preserved]；NCT00634712）。

"点击查看英文标题和摘要"

Age-Related Characteristics and Outcomes of Patients With Heart Failure With Preserved Ejection Fraction

BACKGROUND Although heart failure with preserved ejection fraction (HFpEF) is considered a disease of the elderly, younger patients are not spared from this syndrome. OBJECTIVES This study therefore investigated the associations among age, clinical characteristics, and outcomes in patients with HFpEF. METHODS Using data on patients with left ventricular ejection fraction ≥45% from 3 large HFpEF trials (TOPCAT [Aldosterone Antagonist Therapy for Adults With Heart Failure and Preserved Systolic Function], I-PRESERVE [Irbesartan in Heart Failure With Preserved Systolic Function], and CHARM Preserved [Candesartan Cilexetil in Heart Failure Assessment of Reduction in Mortality and Morbidity]), patients were categorized according to age: ≤55 years (n = 522), 56 to 64 years (n = 1,679), 65 to 74 years (n = 3,405), 75 to 84 years (n = 2,464), and ≥85 years (n = 398). This study compared clinical and echocardiographic characteristics, as well as mortality and hospitalization rates, mode of death, and quality of life across age categories. RESULTS Younger patients (age ≤55 years) with HFpEF were more often obese, nonwhite men, whereas older patients with HFpEF were more often white women with a higher prevalence of atrial fibrillation, hypertension, and chronic kidney disease (eGFR <60 ml/min/1.73 m2). Despite fewer comorbidities, younger patients had worse quality of life compared with older patients (age ≥85 years). Compared with patients age ≤55 years, patients age ≥85 years had higher mortality (hazard ratio: 6.9; 95% confidence interval: 4.2 to 11.4). However, among patients who died, sudden death was, proportionally, the most common mode of death (p < 0.001) in patients age ≤55 years. In contrast, older patients (age ≥85 years) died more often from noncardiovascular causes (34% vs. 20% in patients age ≤55 years; p < 0.001). CONCLUSIONS Compared with the elderly, younger patients with HFpEF were less likely to be white, were more frequently obese men, and died more often of cardiovascular causes, particularly sudden death. In contrast, elderly patients with HFpEF had more comorbidities and died more often from noncardiovascular causes. (Aldosterone Antagonist Therapy for Adults With Heart Failure and Preserved Systolic Function [TOPCAT]; NCT00094302; Irbesartan in Heart Failure With Preserved Systolic Function [I-PRESERVE]; NCT00095238; Candesartan Cilexetil in Heart Failure Assessment of Reduction in Mortality and Morbidity [CHARM Preserved]; NCT00634712).

更新日期：2019-08-01

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