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Incident Heart Failure and Long-Term Risk for Venous Thromboembolism
Journal of the American College of Cardiology ( IF 24.0 ) Pub Date : 2020-01-01 , DOI: 10.1016/j.jacc.2019.10.058
Christina L Fanola 1 , Faye L Norby 2 , Amil M Shah 3 , Patricia P Chang 4 , Pamela L Lutsey 2 , Wayne D Rosamond 4 , Mary Cushman 5 , Aaron R Folsom 2
Affiliation  

BACKGROUND Heart failure (HF) hospitalization places patients at increased short-term risk for venous thromboembolism (VTE). Long-term risk for VTE associated with incident HF, HF subtypes, or structural heart disease is unknown. OBJECTIVES In the ARIC (Atherosclerosis Risk In Communities) cohort, VTE risk associated with incident HF, HF subtypes, and abnormal echocardiographic measures in the absence of clinical HF was assessed. METHODS During follow-up, ARIC identified incident HF and subcategorized HF with preserved ejection fraction or reduced ejection fraction. At the fifth clinical examination, echocardiography was performed. Physicians adjudicated incident VTE using hospital records. Adjusted Cox proportional hazards models were used to evaluate the association between HF or echocardiographic exposures and VTE. RESULTS Over a mean of 22 years in 13,728 subjects, of whom 2,696 (20%) developed incident HF, 729 subsequent VTE events were identified. HF was associated with increased long-term risk for VTE (adjusted hazard ratio: 3.13; 95% confidence interval: 2.58 to 3.80). In 7,588 subjects followed for a mean of 10 years, the risk for VTE was similar for HF with preserved ejection fraction (adjusted hazard ratio: 4.71; 95% CI: 2.94 to 7.52) and HF with reduced ejection fraction (adjusted hazard ratio: 5.53; 95% confidence interval: 3.42 to 8.94). In 5,438 subjects without HF followed for a mean of 3.5 years, left ventricular relative wall thickness and mean left ventricular wall thickness were independent predictors of VTE. CONCLUSIONS In this prospective population-based study, incident hospitalized HF (including both heart failure with preserved ejection fraction and reduced ejection fraction), as well as echocardiographic indicators of left ventricular remodeling, were associated with greatly increased risk for VTE, which persisted through long-term follow-up. Evidence-based strategies to prevent long-term VTE in patients with HF, beyond time of hospitalization, are needed.

中文翻译:

心力衰竭事件和静脉血栓栓塞的长期风险

背景心力衰竭(HF)住院会增加患者发生静脉血栓栓塞(VTE)的短期风险。与心力衰竭、心力衰竭亚型或结构性心脏病相关的 VTE 长期风险尚不清楚。目标 在 ARIC(社区动脉粥样硬化风险)队列中,评估了与心力衰竭事件、心力衰竭亚型以及无临床心力衰竭情况下异常超声心动图测量相关的 VTE 风险。方法 在随访过程中,ARIC 识别了突发性心力衰竭和射血分数保留或射血分数降低的心力衰竭亚类。在第五次临床检查时,进行了超声心动图检查。医生根据医院记录判定 VTE 事件。调整后的 Cox 比例风险模型用于评估 HF 或超声心动图暴露与 VTE 之间的关联。结果 13,728 名受试者(其中 2,696 名(20%))在平均 22 年内发生了心力衰竭,随后发现了 729 起 VTE 事件。心力衰竭与 VTE 长期风险增加相关(调整后风险比:3.13;95% 置信区间:2.58 至 3.80)。在平均随访 10 年的 7,588 名受试者中,射血分数保留的心力衰竭(调整后的危险比:4.71;95% CI:2.94 至 7.52)和射血分数降低的心力衰竭(调整后的危险比:5.53)发生 VTE 的风险相似。 ;95% 置信区间:3.42 至 8.94)。在 5,438 名无心力衰竭受试者中,平均随访 3.5 年,左心室相对壁厚度和平均左心室壁厚度是 VTE 的独立预测因子。结论 在这项基于人群的前瞻性研究中,住院心力衰竭(包括射血分数保留和射血分数降低的心力衰竭)以及左心室重构的超声心动图指标与 VTE 风险大大增加相关,且 VTE 风险会持续很长时间。长期随访。需要基于证据的策略来预防心衰患者住院后的长期 VTE。
更新日期:2020-01-01
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