Supplementary Material for: Long-term trajectories of biomarkers, functional, and echocardiographic parameters in patients with chronic heart failure from dilated or ischaemic cardiomyopathy

Introduction: The long-term evolution of clinical, echocardiographic and laboratory parameters of cardiac function in patients with chronic heart failure (HF) with either reduced (HFrEF) or mildly reduced (HFmrEF) left ventricular ejection fraction (LVEF) is incompletely characterized. Methods: We identified patients with chronic stable HF who presented at least twice to a university HF outpatient clinic between 1995 and 2021. Trajectories of NYHA functional class, LVEF, left ventricular internal enddiastolic diameter (LVIDD), NT-proBNP concentrations and HF treatment over ten years follow-up were analysed using fractional polynomials. Analyses were repeated after stratifying patients according to aetiology (ischemic vs. dilated) or HF category (HFrEF vs. HFmrEF). Results: A total of 2,132 patients were included, of whom 51% had ischemic and 49% had dilated HF. 86% and 14% were classified as HFrEF and HFmrEF, respectively. Mean LVEF was 28±10%, and median NT-proBNP and eGFR values were 1,170 (385-3,176) pmol/L and 81 (62-100) ml/min/1.73m², respectively. Median follow-up was 5.2 (2.6-9.2) years. Overall, NYHA functional class and LVIDD trajectories were U-shaped, whereas LVEF and NT-proBNP concentrations markedly improved during the first year and remained stable thereafter. However, the evolution of HF parameters significantly differed with respect to HF category and aetiology, with greater improvements seen in patients with HFrEF of non-ischemic origin. Improvements in HF variables were associated with optimization of HF therapy, notably with initiation and up-titration of renin-angiotensin-system blockers. Discussion/Conclusion: This study provides insights into the natural history of HF in a large cohort of well-treated chronic HF outpatients with respect to subgroups of HF and different etiologist.

引言：射血分数降低型心力衰竭（heart failure with reduced left ventricular ejection fraction, HFrEF）与轻度降低型心力衰竭（heart failure with mildly reduced left ventricular ejection fraction, HFmrEF）患者的临床、超声心动图及实验室心功能参数的长期演变特征目前尚未完全明确。
方法：本研究纳入1995年至2021年间至少两次就诊于大学附属心力衰竭门诊的慢性稳定性心力衰竭（chronic heart failure, HF）患者。采用分数多项式（fractional polynomials）法分析10年随访期间的纽约心脏协会功能分级（New York Heart Association, NYHA）、左心室射血分数（left ventricular ejection fraction, LVEF）、左心室舒张末期内径（left ventricular internal enddiastolic diameter, LVIDD）、N末端B型利钠肽原（NT-proBNP）浓度及心力衰竭治疗方案的变化轨迹。随后根据病因（缺血性vs.扩张型）或心力衰竭分类（HFrEF vs. HFmrEF）对患者进行分层后重复上述分析。
结果：本研究共纳入2132例患者，其中51%为缺血性心力衰竭，49%为扩张型心力衰竭；86%归类为HFrEF，14%归类为HFmrEF。受试者平均左心室射血分数为28±10%，中位N末端B型利钠肽原浓度为1170（385~3176）pmol/L，估算肾小球滤过率（estimated glomerular filtration rate, eGFR）中位值为81（62~100）ml/min/1.73m²。中位随访时长为5.2（2.6~9.2）年。整体而言，NYHA功能分级与左心室舒张末期内径的变化轨迹呈U型，而左心室射血分数与N末端B型利钠肽原浓度在首年即出现显著改善，此后维持稳定。但心力衰竭参数的演变趋势随心力衰竭分类与病因存在显著差异，非缺血性HFrEF患者的改善更为显著。心力衰竭相关指标的改善与心力衰竭治疗方案优化相关，特别是肾素-血管紧张素系统阻滞剂（renin-angiotensin-system blockers）的启动与剂量上调。
讨论/结论：本研究针对心力衰竭亚组与不同病因的慢性稳定性心力衰竭门诊患者队列，深入阐明了接受规范治疗的大型慢性心力衰竭门诊患者群体的心力衰竭自然病程特征。