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：对于左心室射血分数（LVEF）降低（射血分数降低型心力衰竭，HFrEF）或轻度降低（射血分数轻度降低型心力衰竭，HFmrEF）的慢性心力衰竭（HF）患者，其心脏功能的临床、超声心动图及实验室指标的长期演变规律尚未完全阐明。
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衰门诊的慢性稳定性心力衰竭患者。采用分数多项式分析法，对10年随访期间的纽约心脏协会（NYHA）心功能分级、左心室射血分数（LVEF）、左心室舒张末期内径（LVIDD）、N末端B型利钠肽原（NT-proBNP）水平及心衰治疗方案的变化轨迹进行分析。随后根据病因（缺血性vs.扩张型）或心衰分型（HFrEF vs. HFmrEF）对患者进行分层，重复上述分析。
结果：本研究共纳入2132例患者，其中51%为缺血性心衰，49%为扩张型心衰；86%归类为HFrEF，14%归类为HFmrEF。患者的平均LVEF为28±10%，NT-proBNP中位数为1170（385~3176）pmol/L，估算肾小球滤过率（eGFR）中位数为81（62~100）ml/min/1.73m²。中位随访时间为5.2（2.6~9.2）年。整体而言，NYHA心功能分级与LVIDD的变化轨迹呈U型曲线，而LVEF及NT-proBNP水平在随访第一年即显著改善，此后维持稳定。但心衰指标的演变规律随心衰分型及病因存在显著差异：非缺血性病因的HFrEF患者改善更为明显。心衰相关指标的改善与心衰治疗优化密切相关，尤其是肾素-血管紧张素系统抑制剂的启用与剂量上调。
讨论/结论：本研究针对大型接受规范治疗的慢性心衰门诊患者队列，分析了不同心衰亚组及病因下心衰的自然病程，为相关领域提供了新的认知。