射血分数中间值的心力衰竭患者的临床特征及预后研究

背景 射血分数中间值的心力衰竭(HFmrEF)作为心力衰竭新增分型,其病理生理机制、群体特征、合并症及临床特征与射血分数降低的心力衰竭(HFrEF)患者不尽相同.目的 探讨HFmrEF患者的临床特征及预后,以期为HFmrEF患者的临床诊治提供一定参考.方法 本研究为回顾性研究.选取2016年6月—2019年6月在石河子...

Clinical Characteristics and Prognosis of Patients with Heart Failure with Mid-range Ejection Fraction

Background Heart failure with mid-range ejection fraction(HFmrEF)is a new type of heart failure,its pathophysiological mechanism,population characteristics,complications and clinical features are not the same as in patients with heart failure with reduced ejection fraction(HFrEF).Objective To explore the clinical characteristics and prognosis of HFmrEF patients,so as to provide some reference for the clinical diagnosis and treatment of HFmrEF patients.Methods This study is a retrospective study.Six hundred fifty-four patients with heart failure who were hospitalized in the Department of Vascular Medicine,First Affiliated Hospital,College of Medical,Shihezi University from June 2016 to June 2019 were selected as the research objects.All patients were divided into HFrEF groupleft ventricular ejection fraction(LVEF)<40%,n=299],HFmrEF group(40≤LVEF<50%,n=153)and heart failure with preserved ejection fraction(HFpEF)group(LVEF≥50%,n=202)according to LVEF.The baseline information,laboratory examination indexes within 24 hours after admission and echocardiography indexes were collected in the three groups.All patients were followed up for one year,the incidence and time of all-cause death,and incidence and time of readmission due to heart failure were recorded.Results The age of HFmrEF group and HFrEF group was lower than that of HFpEF group,and the age of HFrEF group was lower than that of HFmrEF group(P<0.05);the female proportion of HFrEF group was lower than that of HFmrEF group and HFpEF group(P<0.05);the heart rate of HFmrEF group and HFrEF group was higher than that in HFpEF group,and New York Heart Association(NYHA)grade was better than that in HFpEF group,and the proportion of patients with history of diabetes and old myocardial infarction was higher than that of HFpEF group,and the proportion of patients with history of atrial fibrillation and chronic obstructive pulmonary disease(COPD)was lower than that of HFpEF group(P<0.05).The serum creatinine,blood uric acid,fasting blood glucose,neutrophil to lymphocyte ratio(NLR),N-terminal B-type natriuretic peptide(NTproBNP)of HFmrEF group and HFrEF group were higher than those of HFpEF group,high density lipoprotein was lower than that in HFpEF group(P<0.05);and the serum creatinine,blood uric acid,fasting blood glucose,NLR,NT-proBNP of HFrEF group were higher than those in HFmrEF group,high density lipoprotein was lower than that in HFmrEF group(P<0.05).The left atrial diameter and left ventricular end diastolic diameter(LVEDD)of HFmrEF group and HFrEF group were larger than those in HEpEF group,and the left atrial diameter and LVEDD of HFrEF group were larger than those in HFmrEF group(P<0.05).Spearman rank correlation analysis showed that heart failure classification was positively correlated with serum creatinine(r=0.110),blood uric acid(r=0.264),fasting blood glucose(r=0.139),NLR(r=0.415),NT-proBNP(r=0.571),left atrial diameter(r=0.246)and LVEDD(r=0.607),and negatively correlated with high density lipoprotein(r=-0.144)(P<0.05).During the follow-up,18 patients missed follow-up,the missed follow-up rate was 2.7%,and the average follow-up time was(12.0±1.6)months.Survival curve analysis showed that the 1-year cumulative survival rate and 1-year cumulative no-readmission rate due to heart failure of HFrEF group were lower than those of HEpEF group and HFmrEF group,and the 1-year cumulative no-readmission rate due to heart failure of HFmrEF group was lower than that of HFpEF group(P<0.05).Conclusion The clinical features of HFmrEF patients are similar to those of HFrEF patients,the severity of heart failure and left ventricular remodeling of HFmrEF patients are between HFrEF and HFpEF,the 1-year cumulative survival rate of HFmrEF patients is similar to that of HFpEF patients,and both of them are better than those of HFrEF patients,but the 1-year cumulative no-readmission rate due to heart failure is lower than that of HFpEF patients.