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Long-Term Trajectories of Left Ventricular Ejection Fraction in Patients With Chronic Inflammatory Diseases and Heart Failure: An Analysis of Electronic Health Records
Circulation: Heart Failure ( IF 9.7 ) Pub Date : 2021-08-10 , DOI: 10.1161/circheartfailure.121.008478 Adovich S Rivera 1 , Arjun Sinha 2 , Faraz S Ahmad 2, 3 , Edward Thorp 4 , Jane E Wilcox 2 , Donald M Lloyd-Jones 2, 3 , Matthew J Feinstein 2, 3
Circulation: Heart Failure ( IF 9.7 ) Pub Date : 2021-08-10 , DOI: 10.1161/circheartfailure.121.008478 Adovich S Rivera 1 , Arjun Sinha 2 , Faraz S Ahmad 2, 3 , Edward Thorp 4 , Jane E Wilcox 2 , Donald M Lloyd-Jones 2, 3 , Matthew J Feinstein 2, 3
Affiliation
Background:Immune regulation and inflammation play a role in the pathogenesis and progression of acute and chronic heart failure (HF). Although the clinical course of acute, severe inflammatory cardiomyopathy is well described, the effects of chronic systemic inflammation on cardiovascular function over time are less clear. To investigate this question, we compared trajectories over time in left ventricular ejection fraction for patients with HF with different chronic inflammatory diseases (CIDs): HIV, systemic lupus erythematosus, systemic sclerosis, rheumatoid arthritis, inflammatory bowel disease, and/or psoriasis.Methods:Using a database of patients receiving care in a large metropolitan health care system since January 1, 2000, we analyzed serial, clinically indicated echocardiograms from patients with HF with CIDs and frequency-matched patients with HF without CIDs. We included patients with ≥3 serial echocardiograms (N=974; median 6.1 years between first and most recent echo). We assessed left ventricular ejection fraction trajectories over time using latent trajectory models, then investigated differences in left ventricular ejection fraction trajectories for specific CID subtypes compared with controls.Results:Overall, the majority of patients studied (N=687; 70.5%) had left ventricular ejection fraction trajectories consistent with HF with preserved or midrange EF, whereas 255 (26.2%) had HF with reduced EF and 32 (3.3%) had HF with recovered EF. Compared with non-CID controls with HF, patients with rheumatoid arthritis, inflammatory bowel disease, and systemic lupus erythematosus were significantly more likely than controls to have HF with preserved or midrange EF whereas patients with HIV were significantly more likely to have HF with reduced EF.Conclusions:Among patients with HF with CIDs, distinct left ventricular ejection fraction trajectory patterns associate with different specific individual CIDs. This highlights the heterogeneity of HF subtypes and changes over time across different CIDs.
中文翻译:
慢性炎症性疾病和心力衰竭患者左心室射血分数的长期轨迹:电子健康记录分析
背景:免疫调节和炎症在急慢性心力衰竭(HF)的发病机制和进展中发挥作用。尽管急性、严重炎症性心肌病的临床病程已得到很好的描述,但随着时间的推移,慢性全身炎症对心血管功能的影响尚不清楚。为了研究这个问题,我们比较了患有不同慢性炎症性疾病 (CID) 的心力衰竭患者的左心室射血分数随时间的变化轨迹:HIV、系统性红斑狼疮、系统性硬化症、类风湿性关节炎、炎症性肠病和/或牛皮癣。方法:使用自 2000 年 1 月 1 日以来在大型城市医疗保健系统中接受护理的患者数据库,我们分析了患有 CID 的 HF 患者和不具有 CID 的频率匹配的 HF 患者的连续临床指示超声心动图。我们纳入了连续超声心动图≥3次的患者(N=974;第一次超声心动图与最近一次超声心动图之间的中位时间为6.1年)。我们使用潜在轨迹模型评估了随时间变化的左心室射血分数轨迹,然后研究了特定 CID 亚型与对照组相比左心室射血分数轨迹的差异。结果:总体而言,大多数研究患者(N=687;70.5%)已经离开心室射血分数轨迹与 EF 保留或中等范围的 HF 一致,而 255 名 (26.2%) 患有 EF 降低的 HF,32 名 (3.3%) 患有 EF 恢复的 HF。与患有 HF 的非 CID 对照相比,类风湿性关节炎、炎症性肠病和系统性红斑狼疮患者出现 EF 保留或中度的 HF 的可能性显着高于对照组,而 HIV 患者出现 EF 降低的 HF 的可能性明显更高结论:在患有 CID 的 HF 患者中,不同的左心室射血分数轨迹模式与不同的特定个体 CID 相关。这凸显了 HF 亚型的异质性以及不同 CID 随时间的变化。
更新日期:2021-08-17
中文翻译:
慢性炎症性疾病和心力衰竭患者左心室射血分数的长期轨迹:电子健康记录分析
背景:免疫调节和炎症在急慢性心力衰竭(HF)的发病机制和进展中发挥作用。尽管急性、严重炎症性心肌病的临床病程已得到很好的描述,但随着时间的推移,慢性全身炎症对心血管功能的影响尚不清楚。为了研究这个问题,我们比较了患有不同慢性炎症性疾病 (CID) 的心力衰竭患者的左心室射血分数随时间的变化轨迹:HIV、系统性红斑狼疮、系统性硬化症、类风湿性关节炎、炎症性肠病和/或牛皮癣。方法:使用自 2000 年 1 月 1 日以来在大型城市医疗保健系统中接受护理的患者数据库,我们分析了患有 CID 的 HF 患者和不具有 CID 的频率匹配的 HF 患者的连续临床指示超声心动图。我们纳入了连续超声心动图≥3次的患者(N=974;第一次超声心动图与最近一次超声心动图之间的中位时间为6.1年)。我们使用潜在轨迹模型评估了随时间变化的左心室射血分数轨迹,然后研究了特定 CID 亚型与对照组相比左心室射血分数轨迹的差异。结果:总体而言,大多数研究患者(N=687;70.5%)已经离开心室射血分数轨迹与 EF 保留或中等范围的 HF 一致,而 255 名 (26.2%) 患有 EF 降低的 HF,32 名 (3.3%) 患有 EF 恢复的 HF。与患有 HF 的非 CID 对照相比,类风湿性关节炎、炎症性肠病和系统性红斑狼疮患者出现 EF 保留或中度的 HF 的可能性显着高于对照组,而 HIV 患者出现 EF 降低的 HF 的可能性明显更高结论:在患有 CID 的 HF 患者中,不同的左心室射血分数轨迹模式与不同的特定个体 CID 相关。这凸显了 HF 亚型的异质性以及不同 CID 随时间的变化。