左心室射血分数正常的心力衰竭患者临床特征及相关因素分析

Relevant factors for heart failure with normal ejection fraction in 511 heart failure patients

目的分析左心室射血分数正常的心力衰竭(heart failure with normal ejection fraction,HFNEF)患者的实验室数据、基础疾病、心脏超声指标和危险因素等。方法本研究为单中心研究,共收入我院心内科2010年1月-2013年1月40岁以上全部心力衰竭(heart failure,HF)住院患者511例,其中HFNEF患者186例,射血分数减低的心力衰竭(heart failure with reduced ejection fraction,HFREF)患者325例,比较分析他们的实验室数据、基础疾病和超声指标。结果 HFNEF组占所有HF住院患者的36.4%。与HFREF组相比,HFNEF组多为高龄、女性,其血钠偏高、血红蛋白偏低,多合并高血压病、房颤、脑梗死、肾功能不全。两组N-末端脑钠肽前体(NT-proBNP)均升高,但HFREF组升高更明显(P<0.05);HFNEF组左心室呈对称性肥厚、左心室内径和容积正常或减小。左心室质量指数(left ventricular mass index,LVMI)升高,但程度不如HEREF组显著(P<0.05);女性、高血压病、房颤为HFNEF的独立危险因素(P<0.05)。结论 HFNEF是复杂的综合征,女性、高血压病和房颤是其危险因素。

Objective To analyze the relevant factors （ including laboratory data, basic diseases, echocardiography parameters and risk factors） for heart failure with normal ejection fraction （HFNEF）. Methods Five hundred and eleven HF patients at the age of over 40 years, admitted to our hospital from January 2010 to January 2013, were divided into HFNEF group （n=186） and heart failure with reduced ejection fraction （HFREF） group （n=325）. Their laboratory data, basic diseases and echocardiography parameters were analyzed. Results The patients with HFNEF accounted for 36.4% of all hospitalized HF patients. The age of patients with HFNEF was older, the number of female patients with HFNEF was higher, the serum sodium level was higher while the hemoglobin level was lower, and the incidence of hypertension, atrial fibrillation （AF）, cerebral infarction and renal insufficiency was significantly higher in HFNEF group than in HFREF group （P 〈 0.05）. The serum NT-proBNP level was higher in both groups but significantly higher in HFREF group than in HFNEF group （P 〈 0.05）. The left ventricle was symmetrically hypertrophy in HFNEF group with a shorter diameter and a normal or less volume or a higher left ventricular mass index （LVMI） than those in HFREF group （P 〈 0.05）. Female, hypertension and AF were the independent risk factors for HFNEF （P 〈 0.05）. Conclusion HFNEF is a complex syndrome. Female, hypertension and AF are its important risk factors.