慢性血栓栓塞性肺动脉高压患者中高HFpEF概率的预后意义
Prognostic Implications of High HFpEF Probability in Patients With Chronic Thromboembolic Pulmonary Hypertension.
文献信息
| PMID | 42986926 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Yijia Wang |
| 作者单位 | Center for Respiratory and Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. |
| 期刊 | Clinical cardiology |
| SCI 分区 | Q2 |
| IF | 2.9 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 鼻科 |
中文摘要
背景： 慢性血栓栓塞性肺动脉高压（CTEPH）与左心疾病，尤其是射血分数保留的心力衰竭（HFpEF），尽管病理生理机制不同，但临床表现存在重叠。
目的： 采用HFpEF-ABA算法（年龄、体重指数、心房颤动）描述CTEPH患者中HFpEF的验前概率，并评估其与左心疾病及临床恶化的关联。
方法： 在466例CTEPH患者中，按HFpEF-ABA评分分层（低<25%，中25%-74%，高≥75%），采用Spearman相关分析评估其与常见左心疾病合并症的关联。采用Kaplan-Meier分析和Cox回归评估其与临床恶化的关联，并使用限制性立方样条评估剂量-反应关系及非线性。按性别、吸烟、饮酒、高血压、冠状动脉疾病和阻塞性睡眠呼吸暂停进行亚组分析以评估一致性。我们还评估了在COMPERA 2.0基础上加入HFpEF-ABA评分是否改善对临床恶化的区分能力。
结果： 中等和高HFpEF概率分别见于52.4%（n=244）和9.0%（n=42）的患者。校正后，HFpEF概率每增加一个标准差与临床恶化风险增加约73%相关（p<0.001）。HFpEF概率的结果一致（p<0.05），未见显著的亚组交互作用。在COMPERA 2.0基础上加入HFpEF-ABA改善了区分能力，C指数从0.532提高至0.634（p=0.012）。
结论： 评估CTEPH患者的HFpEF概率可识别该合并症的高危患者，并与现有风险模型整合时提高精确度。
英文摘要
BACKGROUND: Chronic thromboembolic pulmonary hypertension (CTEPH) and left heart disease, particularly heart failure with preserved ejection fraction (HFpEF), show overlapping clinical features despite distinct pathophysiology.
OBJECTIVES: The HFpEF-ABA algorithm (age, body mass index, atrial fibrillation) was used to characterize HFpEF pretest probability in patients with CTEPH and evaluate its association with left heart disease and clinical worsening.
METHODS: Among 466 patients with CTEPH stratified by HFpEF-ABA score (low < 25%, intermediate 25%-74%, high ≥ 75%), Spearman's correlation assessed associations with common left heart disease comorbidities. Kaplan-Meier analysis and Cox regression evaluated associations with clinical worsening, with restricted cubic splines assessing the dose-response relationship and non-linearity. Subgroup analyses by sex, smoking, alcohol use, hypertension, coronary artery disease, and obstructive sleep apnea assessed the consistency. We also evaluated whether adding the HFpEF-ABA score improved COMPERA 2.0 discrimination for clinical worsening.
RESULTS: Intermediate and high HFpEF probability was found in 52.4% (n = 244) and 9.0% (n = 42), respectively. After adjustment, each standard deviation increase in HFpEF probability was associated with an approximately 73% increase in clinical worsening (p < 0.001). Results were consistent for HFpEF probability (p < 0.05), with no significant subgroup interactions. Adding HFpEF-ABA with COMPERA 2.0 improved discrimination, increasing the C-index increasing from 0.532 to 0.634 (p = 0.012).
CONCLUSIONS: Assessing HFpEF probability in patients with CTEPH identifies those at high risk for this comorbidity and improves the precision when integrated with existing risk models.