降低急性心力衰竭患者的心率：左心室射血分数的作用。

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY Accounts of Chemical Research Pub Date : 2024-12-01 Epub Date: 2024-08-08 DOI:10.1080/14017431.2024.2386977

Miguel Lorenzo, Gema Miñana, Patricia Palau, Gonzalo Núñez, Rafael de la Espriella, Enrique Santas, Sandra Villar, Victor Donoso, Eduardo Núñez, Juan Sanchis, Antoni Bayés-Genis, Julio Núñez

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引用次数: 0

摘要

背景：射血分数保留型心力衰竭（HFpEF）患者的心率（HR）对临床的影响一直存在争议。在射血分数保留型心力衰竭患者中，慢性肌无力（CI）已成为一种与疾病严重程度相关的病理生理机制。在这项研究中，我们试图评估急性心力衰竭患者的入院心率是否会因左心室射血分数（LVEF）而有所不同：我们回顾性地纳入了一家三级中心心脏病科连续收治的 3712 名急性心力衰竭（AHF）患者。发病时评估心率值。入院时通过经胸超声心动图评估 LVEF，并将其分为四类：射血分数降低（≤40%）、射血分数轻度降低（41-49%）、射血分数保留（50-64%）和射血分数超常（≥65%）。通过多变量线性回归分析和多项式回归分析评估了 HR 与 LVEF 之间的关系：样本的平均年龄为 73.9 ± 11.3 岁，1,734（47.4%）名女性，1,214（33.2%）、570（15.6%）、1,229（33.6%）和 648（17.7%）名患者的 LVEF 分别≤40%、41-49%、50-64% 和≥65%。入院时的心率中位数为每分钟95次（IQR为78-120），其中1653人（45.2%）患有心房颤动。入院时的心率与 LVEF 呈反比关系。在所有样本中，较低的心率与较高的 LVEF 显著相关（p 结论：心率越低，LVEF 越高：心房颤动入院时的心率是 LVEF 的预测指标，但仅适用于窦性心律患者。

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Lower heart rate in patients with acute heart failure: the role of left ventricular ejection fraction.

Background: The clinical impact of heart rate (HR) in heart failure with preserved ejection fraction (HFpEF) is a matter of debate. Among those with HFpEF, chronotropic incompetence (CI) has emerged as a pathophysiological mechanism linked to the severity of the disease. In this study, we sought to evaluate whether admission heart rate in acute heart failure differs along left ventricular ejection fraction (LVEF).

Methods: We included retrospectively 3,712 consecutive patients admitted for acute heart failure (AHF) in the Cardiology department of a third level center. HR values were assessed at presentation. LVEF was assessed by transthoracic echocardiogram during the index admission and stratified into four categories: reduced ejection fraction ( $\leq$ 40%), mildly reduced ejection fraction (41-49%), preserved ejection fraction (50-64%) and supranormal ejection fraction ( $\geq$ 65%). The association between HR and LVEF was assessed by multivariate linear and multinomial regression analyses.

Results: The mean age of the sample was 73,9 ± 11.3 years, 1,734 (47,4%) were women, and 1,214 (33,2%), 570 (15,6%), 1,229 (33,6%) and 648 (17,7%) patients showed LVEF $\leq$ 40%, 41-49%, 50-64%, and ≥65% respectively. The median HR at admission was 95 (IQR 78-120) beats per minute and 1,653 were on atrial fibrillation (45.2%). There was an inverse relationship between HR at admission and LVEF. Lower HR was significantly associated with a higher LVEF in the whole sample (p < 0,001). This inverse relationship was found in sinus rhythm but not in patients with atrial fibrillation.

Conclusion: HR at admission for AHF is a predictor of LVEF but only in patients with sinus rhythm.

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.