Circulation Journal ( IF 3.3 ) Pub Date : 2021-12-24 , DOI: 10.1253/circj.cj-21-0300 Bolrathanak Oeun 1 , Shungo Hikoso 1 , Daisaku Nakatani 1 , Hiroya Mizuno 1 , Shinichiro Suna 1 , Tetsuhisa Kitamura 2 , Katsuki Okada 1 , Tomoharu Dohi 1 , Yohei Sotomi 1 , Takayuki Kojima 1 , Hirota Kida 1 , Akihiro Sunaga 1 , Taiki Sato 1 , Yasuharu Takeda 1 , Hiroyuki Kurakami 3 , Tomomi Yamada 3 , Shunsuke Tamaki 4 , Haruhiko Abe 5 , Yusuke Nakagawa 6 , Yoshiharu Higuchi 7 , Hisakazu Fuji 8 , Toshiaki Mano 9 , Masaaki Uematsu 7 , Yoshio Yasumura 10 , Takahisa Yamada 4 , Yasushi Sakata 1 ,
Background:Although diastolic dysfunction is important pathophysiology in heart failure with preserved ejection fraction (HFpEF), its prognostic impact in HFpEF patients, including those with atrial fibrillation (AF), remains to be elucidated.
Methods and Results:We included the data for 863 patients (321 patients with AF) registered in a prospective multicenter observational study of patients with HFpEF. Patients were divided into 3 groups according to the 2016 ASE/EACVI recommendations. The primary endpoint was a composite of all-cause death or HF rehospitalization. Median age was 83 years, and 55.5% were female. 196 (22.7%) were classified with normal diastolic function (ND), 253 (29.3%) with indeterminate (ID) and 414 (48.0%) with diastolic dysfunction (DD). The primary endpoint occurred more frequently in patients with DD than in those with ND or ID (log-rank P<0.001 for DD vs. ND, and log-rank P=0.007 for DD vs. ID, respectively). Taking ND as the reference, multivariable Cox regression analysis revealed that DD (hazard ratio (HR): 1.57, 95% confidence interval (CI):1.06–2.32, P=0.024) was independently associated with the composite endpoint, whereas ID (HR: 1.28, 95% CI: 0.84–1.95, P=0.255) was not. DD was associated with the composite endpoint in both patients with and without AF.
Conclusions:HFpEF patients classified with DD using the 2016 ASE/EACVI recommendations had worse clinical outcomes than those with ND or ID. DD may be considered a prognostic marker in patients with HFpEF regardless of AF.
中文翻译：
超声心动图舒张功能障碍对保留射血分数的心力衰竭患者预后的影响——来自 PURSUIT-HFpEF 登记的见解——
背景：尽管舒张功能障碍是射血分数保留型心力衰竭 (HFpEF) 的重要病理生理学，但其对 HFpEF 患者（包括心房颤动 (AF) 患者）的预后影响仍有待阐明。
方法和结果：我们纳入了 HFpEF 患者前瞻性多中心观察研究中登记的 863 名患者（321 名 AF 患者）的数据。根据 2016 年 ASE/EACVI 建议将患者分为 3 组。主要终点是全因死亡或心衰再住院的复合终点。中位年龄为 83 岁，55.5% 为女性。196 例（22.7%）舒张功能正常（ND），253 例（29.3%）不确定（ID），414 例（48.0%）舒张功能障碍（DD）。DD 患者的主要终点发生率高于 ND 或 ID 患者（DD 与 ND 的对数秩 P<0.001，DD 与 ID 的对数秩 P=0.007）。以ND为参考，多变量Cox回归分析显示DD（风险比（HR）：1.57，95%置信区间（CI）：1.06-2.32，P=0。024) 与复合终点独立相关，而 ID (HR: 1.28, 95% CI: 0.84–1.95, P=0.255) 则不是。DD 与合并和不合并 AF 患者的复合终点相关。
结论：使用 2016 年 ASE/EACVI 推荐分类为 DD 的 HFpEF 患者的临床结果比 ND 或 ID 更差。DD 可被视为 HFpEF 患者的预后标志物，而与 AF 无关。
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