不同射血分数心力衰竭患者临床特征和预后的回顾性分析

A retrospective analysis of clinical characteristics and outcomes of heart failure patients with different left ventricular ejection fractions

目的比较不同左心室射血分数（LVEF）心力衰竭（心衰）患者的临床特征和预后。方法纳入因心衰住院的患者1182例，根据其LVEF分为射血分数减低型心衰（HFrEF，LVEF〈40％，313例）、射血分数中间范围型心衰（HFmrEF，LVEF40％～〈50％，287例）、射血分数保留型心衰（HFpEF，LVEF〉150％，582例）3组，对3组进行回顾观察性研究，并进行中位时间为23．7个月的随访，随访率83．6％（941例），HFrEF组、HFmrEF组、HFpEF组的随访率分别为81．3％、84．9％、84．0％。结果（1）在本研究中，HFrEF患者313例（26．5％），HFmrEF患者287例（24．3％），HFpEF患者582例（49．2％）。（2）与HFrEF组相比，HFmrEF组缺血性心脏病更多见。HFmrEF组的年龄、女性比例、收缩压、血尿酸、N末端B型利钠肽前体、血红蛋白及高血压心脏病、贫血、心房颤动患病率等高于HFrEF组，但低于HFpEF组（P值均〈0．01）。（3）本组心衰患者第1、2、5年的全因死亡率分别为10．8％、20．6％、35．9％，3组间第1、2、5年全因死亡率差异均无统计学意义（P值均〉0．05）。结论HFmrEF代表着一个新的、不同的心衰分类，其很多特征介于HFrEF和HFpEF之间。不同LVEF心衰患者全因死亡率差异无统计学意义。

Objective To compare the clinical characteristics, and outcomes of patients with heart failure with different left ventricular ejection fractions （LVEF）. Methods A total of 1 182 hospitalized patients with heart failure （HF） were enrolled and retrospectively studied in the present study. The patients were stratified by LVEF as reduced （ HFrEF, LVEF 〈 40% , n = 313 ） , mid-range （ HFmrEF, 40% ≤ LVEF 〈50%, n =287） and preserved （HFpEF, LVEF≥50%, n =582） ejection fraction groups. Among the 1 182 cases, 941 of them （81.3%, 84. 9%, and 84.0% inHFrEF, HFmrEF and HFpEF groups, respectively） were followed up for an median duration of 27.3 months. Results （ 1 ） Among the study patients, 26. 5% were in HFrEF, 24. 3% in HFmrEF, and 49. 2% in HFpEF groups. （2） Ischemic heart disease with HFmrEF was more frequent than that in patients with HFrEF. The average age, percentage of female subjects, systolic blood pressure, uric acid, N terminal B-type natriuretic peptide precursor （NT- proBNP）, hemoglobin, and the incidence of hypertensive heart disease, anemia, atrial fibrillation in patients with HFmrEF were higher than those in patients with HFrEF, but lower than those in patients with HFpEF （all P〈O. 01）. （3） The all-cause cumulative mortality was 10. 8% at 1 year, 20. 6% at 2 years and 35.9% at 5 years. No difference was observed in the all-cause cumulative mortality at 1 year, 2 years, 5 years among the three groups （ all P 〉 0. 05 ）. Conclusions The HFmrEF patients, as a new and distinct group, were with many intermediate characteristics compared with HFrEF and HFpEF subjects. However, the all-cause mnrtalitv was not significantly different among HF patients with different LVEF.