Background: The association between higher New York Heart Association(NYHA) class and outcomes in patients with heart failure and preserved systolic function is not well known. Methods: We performed a retrospective fo...Background: The association between higher New York Heart Association(NYHA) class and outcomes in patients with heart failure and preserved systolic function is not well known. Methods: We performed a retrospective follow- up study of 988 patients with heart failure with ejection fraction >45% who participated in the DIG trial. Using Cox proportional hazard models, we estimated risks of all- cause mortality, heart failure mortality, all- cause hospitalization, and hospitalization due to worsening heart failure during a median follow- up of 38.5 months. Results: Patients had a median age of 68 years; 41.2% were women and 13.9% , nonwhites. Overall, 23.4% of patients died, and 19.9% were hospitalized because of worsening heart failure. Proportion of patients with NYHA classes I, II, III, and IV were 19.9% , 58.0% , 20.9% , and 1.2% , respectively, and 14.7% , 21.1% , 35.9% , and 58.3% , respectively, died of all causes(P< .001 for trend). Respective rates for heart failure related hospitalizations were 14.2% , 17.1% , 32.5% , and 33.3% (P< .001 for trend). Compared with NYHA class I patients, adjusted hazard ratios(HRs) for all- cause mortality for class II, III, and IV patients were 1.54(95% CI 1.02- 2.32, P=.042), 2.56(95% CI 1.64- 24.01, P< .001), and 8.46(95% CI 3.57- 20.03, P< .001), respectively. Respective adjusted HRs(95% CI) for hospitalization due to heart failure for class II, III, and IV patients were 1.16(0.76- 1.77)(P=.502), 2.27(1.45- 3.56)(P< .001), and 3.71(1.25- 11.02)(P=.018). New York Heart Association classes II through IV were also associated with higher risk of all- cause hospitalization. Conclusion: Higher NYHA classes were associated with poorer outcomes in patients with heart failure and preserved systolic function.展开更多
Background: The mechanisms responsible for impaired cardiovascular hemodynamics during exercise among persons with milder forms of hypertension are not well documented. We examined the relationship of oxygen pulse dur...Background: The mechanisms responsible for impaired cardiovascular hemodynamics during exercise among persons with milder forms of hypertension are not well documented. We examined the relationship of oxygen pulse during exercise, a correlate of stroke volume, with echocardiographic indices of resting left ventricular function to determine whether abnormal contractility and relaxation are related to abnormal cardiovascular dynamics during exercise among such persons. Methods: Subjects were 44 men and 55 women ages 55 to 75 years with mild hypertension but who were otherwise healthy. Resting left ventricular systolic and diastolic functions were assessed with 2-dimensional Doppler echocardiography and tissue Doppler imaging. Oxygen pulse(millimeters per beat)at rest and during multistage treadmill testing was derived from measurements of oxygen consumption and heart rate. The slope of oxygen pulse between successive exercise stages was calculated. Results: After a steep rise in oxygen pulse from rest to stage 1 of exercise, a markedly diminished oxygen pulse slope was seen between subsequent exercise stages. In stepwise regression analysis, the increase in the slope of oxygen pulse from rest to stage 1 was explained by a greater lean body mass(57% , P< .001)and a larger left atrial size(2% , P< .001). After exercise stage 1, the increase in the slope of oxygen pulse was explained by sex(24% , P< .001), higher mitral E/A ratio(6% , P< .001), and higher mitral annular systolic velocity(6% , P< .001). Conclusions: These results suggest that a blunted oxygen pulse response to exercise among older persons with milder forms of hypertension may reflect impaired left ventricular stroke volume changes during exercise secondary to subtle abnormalities in both systolic and diastolic left ventricular functions.展开更多
文摘Background: The association between higher New York Heart Association(NYHA) class and outcomes in patients with heart failure and preserved systolic function is not well known. Methods: We performed a retrospective follow- up study of 988 patients with heart failure with ejection fraction >45% who participated in the DIG trial. Using Cox proportional hazard models, we estimated risks of all- cause mortality, heart failure mortality, all- cause hospitalization, and hospitalization due to worsening heart failure during a median follow- up of 38.5 months. Results: Patients had a median age of 68 years; 41.2% were women and 13.9% , nonwhites. Overall, 23.4% of patients died, and 19.9% were hospitalized because of worsening heart failure. Proportion of patients with NYHA classes I, II, III, and IV were 19.9% , 58.0% , 20.9% , and 1.2% , respectively, and 14.7% , 21.1% , 35.9% , and 58.3% , respectively, died of all causes(P< .001 for trend). Respective rates for heart failure related hospitalizations were 14.2% , 17.1% , 32.5% , and 33.3% (P< .001 for trend). Compared with NYHA class I patients, adjusted hazard ratios(HRs) for all- cause mortality for class II, III, and IV patients were 1.54(95% CI 1.02- 2.32, P=.042), 2.56(95% CI 1.64- 24.01, P< .001), and 8.46(95% CI 3.57- 20.03, P< .001), respectively. Respective adjusted HRs(95% CI) for hospitalization due to heart failure for class II, III, and IV patients were 1.16(0.76- 1.77)(P=.502), 2.27(1.45- 3.56)(P< .001), and 3.71(1.25- 11.02)(P=.018). New York Heart Association classes II through IV were also associated with higher risk of all- cause hospitalization. Conclusion: Higher NYHA classes were associated with poorer outcomes in patients with heart failure and preserved systolic function.
文摘Background: The mechanisms responsible for impaired cardiovascular hemodynamics during exercise among persons with milder forms of hypertension are not well documented. We examined the relationship of oxygen pulse during exercise, a correlate of stroke volume, with echocardiographic indices of resting left ventricular function to determine whether abnormal contractility and relaxation are related to abnormal cardiovascular dynamics during exercise among such persons. Methods: Subjects were 44 men and 55 women ages 55 to 75 years with mild hypertension but who were otherwise healthy. Resting left ventricular systolic and diastolic functions were assessed with 2-dimensional Doppler echocardiography and tissue Doppler imaging. Oxygen pulse(millimeters per beat)at rest and during multistage treadmill testing was derived from measurements of oxygen consumption and heart rate. The slope of oxygen pulse between successive exercise stages was calculated. Results: After a steep rise in oxygen pulse from rest to stage 1 of exercise, a markedly diminished oxygen pulse slope was seen between subsequent exercise stages. In stepwise regression analysis, the increase in the slope of oxygen pulse from rest to stage 1 was explained by a greater lean body mass(57% , P< .001)and a larger left atrial size(2% , P< .001). After exercise stage 1, the increase in the slope of oxygen pulse was explained by sex(24% , P< .001), higher mitral E/A ratio(6% , P< .001), and higher mitral annular systolic velocity(6% , P< .001). Conclusions: These results suggest that a blunted oxygen pulse response to exercise among older persons with milder forms of hypertension may reflect impaired left ventricular stroke volume changes during exercise secondary to subtle abnormalities in both systolic and diastolic left ventricular functions.
