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Prognostic impacts of dynamic cardiac structural changes in heart failure patients with preserved left ventricular ejection fraction

山中 信介 東北大学

2021.03.25

概要

研究目的：左室駆出率（left ventricular ejection fraction; LVEF）が保たれた心不全（heart failure with preserved LVEF; HFpEF）患者における左室リモデリングの進展様式やその病的意義は明らかではない。本研究は、HFpEF患者を対象にして、左室リモデリングの重要な構成要素である左室肥大と左室拡大が予後と関連するのか、またこうした左室リモデリングの状態が経時的にどのように変化するのか、そして、その変化が予後とどのように関連するのか検討を行った。

方法：2006年10月から2010年3月にかけて患者登録が行われ、現在も追跡調査を継続している第二次東北慢性心不全登録研究（Chronic Heart failure Analysis and Registry in the Tohoku district-2; CHART-2）（N=10, 219）において、LVEF>50%を満たす2, 698人のHFpEF患者（平均年齢68.9歳、女性32.1%）を登録時における左室肥大と左室拡大の有無にて以下の3群に分類した; （－）左室肥大/（－）左室拡大（G1, N=989）、（＋）左室肥大/（－）左室拡大（G2, N=1, 448）、（＋）左室肥大/（＋）左室拡大（G3, N=261）。これら3群の予後について比較検討し、続いて3群間の経時的変化と予後との関連について検討した。一次エンドポイントは心血管死と心不全増悪による入院の複合エンドポイントとした。追跡期間中央値は8.7年であった。

結果：G1、G2、G3の順に一次エンドポイントの発生率は有意に増加した。登録時と1年次に心エコー検査が実施可能であった1, 808人のHFpEF患者のうち、多くの患者が1年次に登録時とは異なる群に移行した。具体的には、G1→G2、G2→G1、G2→G3、G3→G2への移行率はそれぞれ27%（182/671）、22%（213/967）、6%（59/967）26%（44/170）であった。単変量Cox比例ハザード回帰分析の結果、G1→G1群をReference群とすると、G2→G3群は、G3→G3群と同様に最も予後不良であった（それぞれ、ハザード比4.65, 95%信頼区間3.09-6.99, P<0.001、ハザード比4.01, 95％信頼区間2.85-5.65, P<0.001）。一方で、G3→G2群はG2→G2群と、同様にG2→G1群はG1→G1群と同等の予後リスクであった。多変量調整後においても以上の結果は同様であった。

結論：HFpEFの左室構造は予後と密接に関連する。そしてHFpEFの左室構造は経時的にダイナミックに変化する。さらに、その変化、すなわち左室肥大および左室拡大の進行と退行は、それぞれ予後の悪化と改善に密接に関連するが、特に左室肥大に加えて、左室拡大が進行する患者の予後が最も不良である。したがって、左室リモデリングと左室リバースリモデリングの視点から、左室構造の経時的変化を注意深く観察し心不全管理を行うことが重要である。

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参考文献

1. Ho KK, Pinsky JL, Kannel WB and Levy D. The epidemiology of heart failure: the Framingham Study. J Am Coll Cardiol. 1993;22:6a-13a.

2. Bleumink GS, Knetsch AM, Sturkenboom MC, Straus SM, Hofman A, Deckers JW, Witteman JC and Stricker BH. Quantifying the heart failure epidemic: prevalence, incidence rate, lifetime risk and prognosis of heart failure: The Rotterdam Study. Eur Heart J. 2004;25:1614-9.

3. Curtis LH, Whellan DJ, Hammill BG, Hernandez AF, Anstrom KJ, Shea AM and Schulman KA. Incidence and prevalence of heart failure in elderly persons, 1994-2003. Arch Intern Med. 2008;168:418-24.

4. Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Das SR, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Jordan LC, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, O'Flaherty M, Pandey A, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Spartano NL, Stokes A, Tirschwell DL, Tsao CW, Turakhia MP, VanWagner LB, Wilkins JT, Wong SS and Virani SS. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation. 2019;139:e56-e528.

5. Gomez-Soto FM, Andrey JL, Garcia-Egido AA, Escobar MA, Romero SP, Garcia-Arjona R, Gutierrez J and Gomez F. Incidence and mortality of heart failure: a community-based study. Int J Cardiol. 2011;151:40-5.

6. Guo Y, Lip GY and Banerjee A. Heart failure in East Asia. Curr Cardiol Rev. 2013;9:112-22.

7. Pillai HS and Ganapathi S. Heart failure in South Asia. Curr Cardiol Rev. 2013;9:102-11.

8. Sakata Y and Shimokawa H. Epidemiology of heart failure in Asia. Circ J. 2013;77:2209-17.

9. Shimokawa H, Miura M, Nochioka K and Sakata Y. Heart failure as a general pandemic in Asia. Eur J Heart Fail. 2015;17:884-92.

10. Okura Y, Ramadan MM, Ohno Y, Mitsuma W, Tanaka K, Ito M, Suzuki K, Tanabe N, Kodama M and Aizawa Y. Impending epidemic: future projection of heart failure in Japan to the year 2055. Circ J. 2008;72:489-91.

11. Lloyd-Jones DM, Larson MG, Leip EP, Beiser A, D'Agostino RB, Kannel WB, Murabito JM, Vasan RS, Benjamin EJ and Levy D. Lifetime risk for developing congestive heart failure: the Framingham Heart Study. Circulation. 2002;106:3068-72.

12. Komajda M and Lam CS. Heart failure with preserved ejection fraction: a clinical dilemma. Eur Heart J. 2014;35:1022-32.

13. Parikh KS, Sharma K, Fiuzat M, Surks HK, George JT, Honarpour N, Depre C, Desvigne-Nickens P, Nkulikiyinka R, Lewis GD, Gomberg-Maitland M, O'Connor CM, Stockbridge N, Califf RM, Konstam MA, Januzzi JL, Jr., Solomon SD, Borlaug BA, Shah SJ, Redfield MM and Felker GM. Heart failure with preserved ejection fraction expert panel report: current controversies and implications for clinical trials. JACC Heart Fail. 2018;6:619- 32.

14. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, Gonzalez-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P and Group ESCSD. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37:2129-200.

15. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Jr., Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WH, Tsai EJ and Wilkoff BL. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2013;128:e240-327.

16. Owan TE, Hodge DO, Herges RM, Jacobsen SJ, Roger VL and Redfield MM. Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med. 2006;355:251-9.

17. Oktay AA, Rich JD and Shah SJ. The emerging epidemic of heart failure with preserved ejection fraction. Curr Heart Fail Rep. 2013;10:401-10.

18. Ambrosy AP, Fonarow GC, Butler J, Chioncel O, Greene SJ, Vaduganathan M, Nodari S, Lam CSP, Sato N, Shah AN and Gheorghiade M. The global health and economic burden of hospitalizations for heart failure: lessons learned from hospitalized heart failure registries. J Am Coll Cardiol. 2014;63:1123-33.

19. Bhatia RS, Tu JV, Lee DS, Austin PC, Fang J, Haouzi A, Gong Y and Liu PP. Outcome of heart failure with preserved ejection fraction in a population-based study. N Engl J Med. 2006;355:260-9.

20. Chioncel O, Lainscak M, Seferovic PM, Anker SD, Crespo-Leiro MG, Harjola VP, Parissis J, Laroche C, Piepoli MF, Fonseca C, Mebazaa A, Lund L, Ambrosio GA, Coats AJ, Ferrari R, Ruschitzka F, Maggioni AP and Filippatos G. Epidemiology and one-year outcomes in patients with chronic heart failure and preserved, mid-range and reduced ejection fraction: an analysis of the ESC Heart Failure Long-Term Registry. Eur J Heart Fail. 2017;19:1574-85.

21. Tsuji K, Sakata Y, Nochioka K, Miura M, Yamauchi T, Onose T, Abe R, Oikawa T, Kasahara S, Sato M, Shiroto T, Takahashi J, Miyata S, Shimokawa H. Characterization of heart failure patients with mid-range left ventricular ejection fraction-a report from the CHART-2 Study. Eur J Heart Fail. 2017;19:1258-69.

22. Shah AM and Pfeffer MA. The many faces of heart failure with preserved ejection fraction. Nat Rev Cardiol. 2012;9:555-6.

23. Paulus WJ and Tschöpe C. A novel paradigm for heart failure with preserved ejection fraction: comorbidities drive myocardial dysfunction and remodeling through coronary microvascular endothelial inflammation. J Am Coll Cardiol. 2013;62:263-71.

24. Lam CS, Donal E, Kraigher-Krainer E and Vasan RS. Epidemiology and clinical course of heart failure with preserved ejection fraction. Eur J Heart Fail. 2011;13:18-28.

25. Katz DH, Beussink L, Sauer AJ, Freed BH, Burke MA and Shah SJ. Prevalence, clinical characteristics, and outcomes associated with eccentric versus concentric left ventricular hypertrophy in heart failure with preserved ejection fraction. Am J Cardiol. 2013;112:1158-64.

26. Shah AM, Claggett B, Sweitzer NK, Shah SJ, Anand IS, O'Meara E, Desai AS, Heitner JF, Li G, Fang J, Rouleau J, Zile MR, Markov V, Ryabov V, Reis G, Assmann SF, McKinlay SM, Pitt B, Pfeffer MA and Solomon SD. Cardiac structure and function and prognosis in heart failure with preserved ejection fraction: findings from the echocardiographic study of the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) Trial. Circ Heart Fail. 2014;7:740-51.

27. Zile MR, Gottdiener JS, Hetzel SJ, McMurray JJ, Komajda M, McKelvie R, Baicu CF, Massie BM, Carson PE and Investigators IP. Prevalence and significance of alterations in cardiac structure and function in patients with heart failure and a preserved ejection fraction. Circulation. 2011;124:2491-501.

28. Cohn JN, Ferrari R and Sharpe N. Cardiac remodeling-concepts and clinical implications: a consensus paper from an international forum on cardiac remodeling. J Am Coll Cardiol. 2000;35:569-82.

29. Konstam MA, Kramer DG, Patel AR, Maron MS and Udelson JE. Left ventricular remodeling in heart failure: current concepts in clinical significance and assessment. JACC Cardiovasc Imaging. 2011;4:98-108.

30. Pfeffer MA and Braunwald E. Ventricular remodeling after myocardial infarction. Experimental observations and clinical implications. Circulation. 1990;81:1161-72.

31. Zile MR, Gaasch WH, Patel K, Aban IB and Ahmed A. Adverse left ventricular remodeling in community-dwelling older adults predicts incident heart failure and mortality. JACC Heart Fail. 2014;2:512-22.

32. Shiba N, Nochioka K, Miura M, Kohno H, Shimokawa H. Trend of westernization of etiology and clinical characteristics of heart failure patients in Japan-first report from the CHART-2 study. Circ J. 2011;75:823-33.

33. Hunt SA. ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure). J Am Coll Cardiol. 2005;46:e1-82.

34. McKee PA, Castelli WP, McNamara PM and Kannel WB. The natural history of congestive heart failure: The Framingham Study. N Engl J Med. 1971;285:1441-6.

35. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, Lancellotti P, Muraru D, Picard MH, Rietzschel ER, Rudski L, Spencer KT, Tsang W and Voigt JU. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015;28:1-39 e14.

36. Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I and Reichek N. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol. 1986;57:450-8.

37. Aleong RG, Mulvahill MJ, Halder I, Carlson NE, Singh M, Bloom HL, Dudley SC, Ellinor PT, Shalaby A, Weiss R, Gutmann R, Sauer WH, Narayanan K, Chugh SS, Saba S and London B. Left ventricular dilatation increases the risk of ventricular arrhythmias in patients with reduced systolic function. J Am Heart Assoc. 2015;4:e001566.

38. Lee TH, Hamilton MA, Stevenson LW, Moriguchi JD, Fonarow GC, Child JS, Laks H and Walden JA. Impact of left ventricular cavity size on survival in advanced heart failure. Am J Cardiol. 1993;72:672-6.

39. St John Sutton M, Pfeffer MA, Plappert T, Rouleau JL, Moye LA, Dagenais GR, Lamas GA, Klein M, Sussex B, Goldman S and et al. Quantitative two- dimensional echocardiographic measurements are major predictors of adverse cardiovascular events after acute myocardial infarction. The protective effects of captopril. Circulation. 1994;89:68-75.

40. Wong M, Staszewsky L, Latini R, Barlera S, Glazer R, Aknay N, Hester A, Anand I and Cohn JN. Severity of left ventricular remodeling defines outcomes and response to therapy in heart failure: Valsartan heart failure trial (Val-HeFT) echocardiographic data. J Am Coll Cardiol. 2004;43:2022-7.

41. Solomon SD, Anavekar N, Skali H, McMurray JJ, Swedberg K, Yusuf S, Granger CB, Michelson EL, Wang D, Pocock S and Pfeffer MA. Influence of ejection fraction on cardiovascular outcomes in a broad spectrum of heart failure patients. Circulation. 2005;112:3738-44.

42. Dunlay SM, Roger VL and Redfield MM. Epidemiology of heart failure with preserved ejection fraction. Nat Rev Cardiol. 2017;14:591-602.

43. Doughty RN, Whalley GA, Gamble G, MacMahon S and Sharpe N. Left ventricular remodeling with carvedilol in patients with congestive heart failure due to ischemic heart disease. J Am Coll Cardiol. 1997;29:1060-6.

44. Groenning BA, Nilsson JC, Sondergaard L, Fritz-Hansen T, Larsson HBW and Hildebrandt PR. Antiremodeling effects on the left ventricle during beta- blockade with metoprolol in the treatment of chronic heart failure. J Am Coll Cardiol. 2000;36:2072-80.

45. Greenberg B, Quinones MA, Koilpillai C, Limacher M, Shindler D, Benedict C and Shelton B. Effects of long-term enalapril therapy on cardiac structure and function in patients with left ventricular dysfunction. Results of the SOLVD echocardiography substudy. Circulation. 1995;91:2573-81.

46. Yusuf S, Pitt B, Davis CE, Hood WB and Cohn JN. Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. N Engl J Med. 1991;325:293-302.

47. Sola S, Mir MQ, Lerakis S, Tandon N and Khan BV. Atorvastatin improves left ventricular systolic function and serum markers of inflammation in nonischemic heart failure. J Am Coll Cardiol. 2006;47:332-7.

48. Dunlay SM, Roger VL, Weston SA, Jiang R and Redfield MM. Longitudinal changes in ejection fraction in heart failure patients with preserved and reduced ejection fraction. Circ Heart Fail. 2012;5:720-6.

49. Savarese G, Vedin O, D'Amario D, Uijl A, Dahlstrom U, Rosano G, Lam CSP and Lund LH. Prevalence and prognostic implications of longitudinal ejection fraction change in heart failure. JACC Heart Fail. 2019;7:306-17.

50. Shah AM. Ventricular remodeling in heart failure with preserved ejection fraction. Curr Heart Fail Rep. 2013;10:341-9.

51. Bang CN, Gerdts E, Aurigemma GP, Boman K, de Simone G, Dahlof B, Kober L, Wachtell K and Devereux RB. Four-group classification of left ventricular hypertrophy based on ventricular concentricity and dilatation identifies a low- risk subset of eccentric hypertrophy in hypertensive patients. Circ Cardiovasc Imaging. 2014;7:422-9.

52. Garg S, de Lemos JA, Ayers C, Khouri MG, Pandey A, Berry JD, Peshock RM and Drazner MH. Association of a 4-tiered classification of LV hypertrophy with adverse CV outcomes in the general population. JACC Cardiovasc Imaging. 2015;8:1034-41.

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