射血分数正常的老年心力衰竭患者临床特点分析

Clinical characteristics of heart failure with normal ejection fraction in elderly patients

目的分析射血分数正常的心力衰竭(heart failure with normal ejection fraction,HFNEF)老年患者的临床特点。方法本研究为单中心研究,共收集我院心内科2010年1月-2013年1月住院老年患者583例(≥60岁),其中心力衰竭(heart failure,HF)者407例,无心力衰竭对照者176例,HF组又被分为HFNEF 171例,射血分数减低的心力衰竭(heart failure with reduced ejection fraction,HFREF)236例,比较各组基础疾病、实验室指标、超声指标以及药物治疗史等。结果与HFREF组相比,HFNEF组多为高龄、女性,其收缩压偏高,血钠偏高,多合并高血压病、房颤和脑梗死,而患冠心病、心肌梗死、糖尿病的比例偏低,有血管紧张素Ⅱ受体拮抗剂(angiotensinⅡreceptor blockers,ARB)、钙通道阻滞剂(calcium channel blockers,CCB)用药史的患者比例偏高,有血管紧张素转化酶抑制剂(angiotensin converting enzyme inhibitor,ACEI)、利尿剂、地高辛、硝酸酯类药物用药史的比例偏低(P<0.05);HFNEF组左心室呈对称性肥厚,左心室内径和容积正常。与对照组比较,N-末端脑钠肽前体显著升高(P<0.01);左心房内径扩大,左心室质量指数(left ventricular mass index,LVMI)升高(P<0.01)。房颤为老年HFNEF患者的独立危险因素(P<0.05)。结论在住院老年HF患者中,将近50%为HFNEF患者,房颤是此类人群的独立危险因素。

Objective To analyze the clinical characteristics of heart failure with normal ejection fraction （HFNEF） in elderly patients. Methods Five hundred and eighty-three elderly patients with their age ≥ 60 years admitted to our hospital from January 2010 to January 2013 were divided into HF group （n=407） and control group （n=176）. Patients in HF group were further divided into HFNEF group （n=171） and heart failure with reduced ejection fraction （HFREF） group （n=236）. Their laboratory data, basic diseases, echocardiography parameters and drug treatment history were analyzed. Results The age was older, the number of female patients was greater, the systolic blood pressure and serum sodium level were higher, and the incidence of hypertension, atrial fibrillation （AF） and cerebral infarction was higher whereas the incidence of coronary heart disease （CHD）, myocardiac infarction and diabetes mellitus （DM） was lower, the number of patients with a drug use history of angiotensin II receptor blockers （ARB） was greater, the number of patients with a drug use history of angiotensin converting enzyme inhibitor （ACEI）, diuretics, digoxin and nitric lipids was lower in HFNEF group than in HFREF group （P 〈 0.05）. Left ventricular symmetric hypertrophy was detected in HFNEF group with a normal left ventricular diameter and volume. The serum NT-proBNP level and left ventricular mass index （LVMI） were higher whereas the left atrial diameter was longer in HFNEF group than in control group （P 〈 0.01）. AF was the independent risk factor for HFNEF in elderly patients （P 〈 0.05）. Conclusion About 50% of elderly HF patients suffer from HFNEF. AF is the independent risk factor for such patients.