射血分数正常心力衰竭与射血分数下降心力衰竭的临床特征与预后

目的观察射血分数正常心力衰竭(HFNEF)与射血分数下降心力衰竭(HFREF)的临床特征及预后。方法回顾性分析2008年2月-2011年2月因心力衰竭入住天津医科大学总医院心血管内科患者的临床资料并随访,经Cox回归模型多因素回归分析危险因素及与预后的关系。结果 483例心力衰竭患者中,HFNEF192例,占39.66%,HFREF291例,占60.34%。HFNEF组年龄([72±10)岁]、左室质量指数([132.93±42.74)g/m2]较HFREF组[年龄(69±12)岁、左室质量指数(108.63±31.20)g/m2]大,差异有统计学意义(P<0.01)。HFNEF组尿酸水平、肌酐水平、肌钙蛋白水平较HFREF组低,差异有统计学意义(P<0.05)。HFNEF组女性、高血压、心房颤动、糖尿病、瓣膜性心脏病、贫血患者比例高,冠状动脉性心脏病(CHD)患者比例低,差异均有统计学意义(P<0.01或P<0.05)。肥厚性心肌病患者均为HFNEF,扩张性心肌病患者均为HFREF,差异有统计学意义(P<0.01)。平均随访(23.24±8.9)月,两组心源性死亡率(包括急性心肌梗死、急性左心衰竭、恶性心律失常等)比较,差异无统计学意义(P=0.222)。经Cox回归模型多因素回归分析,NYHA分级、氨基末端脑肭肽前体(NT-proBNP)水平、体质指数(BMI)和CHD是HFREF患者预后的独立预测因素,心房颤动、NT-proBNP水平、女性及高血压是HFNEF患者预后的独立预测因素。结论 HFNEF与HFREF临床特征不同,影响预后的因素不同,预后相似。

Clinical Features and Prognosis of Heart Failure with Normal Ejection Fraction and Reduced Ejection Fraction

Objective To observe the clinical features and prognosis of heart failure with normal ejection fraction(HFNEF)and heart failure with reduced ejection fraction(HFREF).Methods The clinical data of the patients who admitted to Tianjin Medical University General Hospital with a diagnosis of heart failure from February 2008 to February 2011 were studied and they were visited in the follow-up.A Cox proportional hazards model was used to identify the relationship of the clinical data and the outcome.Results Of 483 cases of heart failure patients,192 cases were HFNEF,accounting for 39.66%,and 291 cases were HFREF,for 60.34%.Compared with patient with HFREF,the age and left ventricular mass were larger in HFNEF [(72±10)vs.(69±12)years,(132.93±42.74)vs.(108.63±31.20)g/m2,P<0.01].LVDd and Uric acid [(60.23±8.84)vs.(49.04±6.96)mm and(347.38±137.84)vs.(420.32±162.05)μmol/L,P<0.01],creatinine and TnT concentration [(96.67±55.98)vs.(106.21±48.06)mmol/L and(0.16±0.43)vs.(0.25±0.48)pg/ml,P<0.05] were less in HFNEF.Patients with HFNEF were more likely to be female and had a higher incidence of atrial fibrillation,hypertension(P<0.01),diabetes,valvular heart disease and anemia(P<0.05).Fewer patients with coronary heart disease were in HFNEF(P<0.01).Patients with hypertrophic cardiomyopathy were all in HFNEF,and ones with dilated cardiomyopathy were all in HFREF.During the(23.24±8.9)months follow-up,the difference of the mortality of the two groups was not statistically significant(43.62% vs.49.65%,P=0.222).The results of a multivariate analysis,using a Cox proportional hazards model to identify predictors of the prognosis of heart failure,revealed NYHA classification,N-terminal pro-brain natriuretic peptide(NT-proBNP)levels,body mass index(BMI)and coronary heart disease(CHD)were identified as independent predictors of cardiovascular events rate in HFREF,while atrial fibrillation,NT-proBNP levels,female and hypertension were independent predictors in HFNEF.Conclusion HFNEF and HFREF have different clinical features and different factors affecting prognosis,but with similar prognosis.