老年HFpEF急诊患者的临床表型潜在剖面分析及与病情转归的关系探讨

doi:10.3969/j.issn.1003-9198.2025.12.016

摘要/Abstract

摘要： 目的对老年射血分数保留型心力衰竭(HFpEF)急诊患者的临床表型进行潜在剖面分析,并分析其与病情转归的关系。方法选取2023—2024年青海大学附属医院接诊的老年HFpEF急诊患者。根据HFpEF病理生理机制选取核心变量,通过潜在剖面分析确定最佳类别。随访30 d,根据患者病情转归分为不良组和良好组。采用多因素logistic回归分析转归的独立影响因素。结果潜在剖面模型分析确定4种类别模式为最优结果,潜在类别归到此4种特别类型的概率为96.24%～99.02%,可信度高;将4种临床表型分别命名为代谢-高血压型、多病共存型、炎症-容量超负荷型、孤立性舒张功能障碍型,分布率分别为35.00%、30.00%、25.00%、10.00%;多因素logistic回归模型显示,年龄(OR=1.919,95%CI:1.278～2.882)、合并房颤(OR=2.272,95%CI:1.464～3.526)、左心房容积指数(LAVI)(OR=2.979,95%CI:1.294～6.858)、炎症-容量超负荷型(OR=3.201,95%CI:1.423～7.201)是影响老年HFpEF急诊患者转归不良的危险因素(P＜0.05)。结论潜在剖面分析将老年HFpEF急诊患者分为代谢-高血压型、多病共存型、炎症-容量超负荷型、孤立性舒张功能障碍型共4种临床表型,其中炎症-容量超负荷型患者预后最差,是影响患者病情转归的危险因素。

关键词: 老年人, 心力衰竭, 潜在剖面分析, 转归预测

Abstract: Objective To perform latent profile analysis (LPA) on the clinical phenotypes of elderly emergency patients with heart failure with preserved ejection fraction (HFpEF) and explore their associations with clinical outcomes. Methods A total of 300 elderly emergency patients with HFpEF admitted to the Affiliated Hospital of Qinghai University from January 2023 to December 2024 were selected. Core variables were chosen based on the pathophysiological mechanisms of HFpEF. LPA was conducted to determine the optimal classification. Patients were followed for 30 days and divided into adverse or favorable outcome groups based on their disease progression. Binary multivariate logistic regression was used to identify independent factors influencing outcomes. Results The 4-class model was identified as optimal. The probability of latent categories being assigned to specific types was 96.24%～99.02%, indicating high reliability. The four clinical phenotypes were designated as metabolic-hypertensive type (35.00%), multimorbidity coexistence type (30.00%), inflammatory-volume overload type (25.00%), and isolated diastolic dysfunction type (10.00%). Multivariate logistic regression revealed that advanced age (OR=1.919, 95%CI: 1.278-2.882), comorbid atrial fibrillation (OR=2.272, 95%CI: 1.464-3.526), elevated left atrial volume index (LAVI) (OR=2.979, 95%CI: 1.294-6.858), and the inflammatory-volume overload phenotype (OR=3.201, 95%CI: 1.423-7.201)were independent risk factors for adverse outcomes. Conclusions LPA classifies elderly emergency HFpEF patients into four clinical phenotypes: metabolic-hypertensive, multimorbidity coexistence, inflammatory-volume overload, and isolated diastolic dysfunction. Patients with the inflammatory-volume overload phenotype have the worst prognosis, identifying it as a significant risk factor for adverse clinical outcomes.

Key words: aged, heart failure, latent profile analysis, prognosis prediction

中图分类号:

R 541.6

马玥, 侯明, 蔡长霞, 李肃, 马海军. 老年HFpEF急诊患者的临床表型潜在剖面分析及与病情转归的关系探讨[J]. 实用老年医学, 2025, 39(12): 1269-1273.

MA Yue, HOU Ming, CAI Changxia, LI Su, MA Haijun. Latent profile analysis of clinical phenotypes in elderly emergency patients with HFpEF and their relationship with disease progression[J]. Practical Geriatrics, 2025, 39(12): 1269-1273.

参考文献

[1] BORLAUG B A, SHARMA K, SHAH S J, et al. Heart failure with preserved ejection fraction: JACC scientific statement[J]. J Am Coll Cardiol, 2023, 81(18): 1810-1834.
[2] KHAN M S, SHAHID I, BENNIS A, et al. Global epidemiology of heart failure[J]. Nat Rev Cardiol, 2024, 21(10): 717-734.
[3] HAMO C E, DEJONG C, HARTSHORNE-EVANS N, et al. Heart failure with preserved ejection fraction[J]. Nat Rev Dis Primers, 2024, 10: 55.
[4] MCDONAGH T A, METRA M, ADAMO M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: developed by the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)[J]. Eur J Heart Fail, 2022, 24(1):4-131.
[5] WANG M, LI D, LI J, et al. Professional competencies in geriatric nursing for geriatric nurses: a latent profile analysis[J]. BMC Nurs, 2024, 23(1): 512.
[6] TEIN J Y, COXE S, CHAM H. Statistical power to detect the correct number of classes in latent profile analysis[J]. Struct Equ Modeling, 2013, 20(4): 640-657.
[7] 射血分数保留的心力衰竭诊断与治疗中国专家共识制定工作组. 射血分数保留的心力衰竭诊断与治疗中国专家共识2023[J]. 中国循环杂志, 2023, 38(4): 375-393.
[8] MATSUSHITA K, HARADA K, KOHNO T, et al. Comparison of clinical characteristics and prognostic factors in patients with heart failure with preserved ejection fraction with and without renal dysfunction[J]. Minerva Cardiol Angiol, 2024, 72(6): 615-624.
[9] CHEN M, LI W, RAN Q. Incidence and risk factors of heart failure with preserved ejection fraction in elderly patients with hypertension[J]. BMC Cardiovasc Disord, 2024, 24(1): 742.
[10] VU H H, MOELLMER S A, MCCARTY O J T, et al. New mechanisms and therapeutic approaches to regulate vascular permeability in systemic inflammation[J]. Curr Opin Hematol, 2025, 32(3): 130-137.
[11] BAUDRY N, CAMPEANU A, AUSSEL C, et al. IL-1β primed mesenchymal stromal cells moderate hemorrhagic shock-induced vascular permeability[J]. J Transl Med, 2024, 22(1): 1143.
[12] RICCI F, SARAULLO S, BOCCATONDA A, et al. Early prescription of SGLT2i for acute patient care: from current evidence to future directions[J]. Curr Probl Cardiol, 2025, 50(8): 103081.
[13] BERGER M, MÄRZ W, NIESSNER A, et al. IL-6 and hsCRP predict cardiovascular mortality in patients with heart failure with preserved ejection fraction[J]. ESC Heart Fail, 2024, 11(6): 3607-3615.
[14] MELENDO-VIU M, RAPOSEIRAS-ROUBÍN S, ABU-ASSI E, et al. Heart failure in older patients with atrial fibrillation: incidence and risk factors[J]. Rev Esp Cardiol: Engl Ed, 2024, 77(1): 19-26.
[15] RAKISHEVA A, SOLOVEVA A, SHCHENDRYGINA A, et al. Heart failure with preserved ejection fraction and frailty:from young to superaged coexisting HFpEF and frailty[J]. Int J Heart Fail, 2024, 6(3): 93-106.
[16] VERMA S, BUTLER J, BORLAUG B A, et al. Atrial fibrillation and semaglutide effects in obesity-related heart failure with preserved ejection fraction: step-HFpEF program[J]. J Am Coll Cardiol, 2024, 84(17): 1603-1614.