左室射血分数正常的心力衰竭患者的临床特点及左室功能分析

Clinical features and left ventricular （LV） dysfunction in heart failure patients with normal ejection fraction

将住院的心力衰竭（心衰）患者100例分为左室射血分数（LVEF）正常心衰症状组和LVEF降低心衰症状组各50例,另以50例健康体检者为对照组.比较各组在NYHA心功能分级、基础病因、收缩期峰值（Sm）、舒张早期峰值速度（Ea）、心房收缩峰值速度（Aa）、跨二尖瓣舒张早期血流速度峰值（E）/Ea、血浆B型利钠肽原浓度的差异.结果 显示,LVEF正常心衰症状组和LVEF降低心衰症状组的NYHA心功能分级差异无统计学意义.LVEF正常心衰症状组常见病因为高血压病和糖尿病.正常对照组、LVEF正常心衰症状组、LVEF降低心衰症状组的Sm值依次下降,与血浆B型利钠肽原水平负相关（r=-0.35,P＜0.05）.E/Ea比值依次上升,与BNP水平呈正相关（r=0.728,P＜0.05）.提示通过组织超声多普勒测定的E/Ea比值和BNP有助于LVEF正常心衰患者的诊断。

100 inpatients with heart failure were divided into two groups： 50 with preserved LVEF and 50 with reduced LVEF. Another 50 age-matched healthy subjects served as the control group. The severity and etiology of heart failure, tissue Doppler imaging indexes （Sm;Ea;Aa;E/Ea） and plasma BNP concentrations were compared among the three groups. There was no difference in terms of NYHA classification between groups of preserved LVEF and reduced LVEF. Hypertension and DM are more common in the group of preserved LVEF. The index of Sm decreased most significantly in the group of reduced LVEF, and was negatively correlated with the BNP concentration （r = -0. 35, P 〈 0. 05 ）. The ratio of E/Ea increased gradually among the three groups, and was positively correlated with the BNP concentration （ r = 0. 728, P 〈 0. 05 ）. The LV filling index E/Ea and the BNP concentration may be helpful in the diagnosis of heart failure patients with preserved LVEF.