射血分数保留心力衰竭的临床特征及预后因素分析

Clinical features and prognostic factors of heart failure with preserved ejection fraction

目的:比较射血分数保留心力衰竭(HFpEF)的临床特征及预后因素分析。方法:将523例心力衰竭(心衰)患者按左室射血分数分为射血分数降低心衰(HFrEF)、射血分数中间范围型心衰(HFmrEF)和HFpEF,比较其临床特征、观察预后指标差异。将274例HFpEF住院患者按年龄分为≥65岁组(228例)和<65岁组(46例),分析≥65岁组HFpEF患者心衰再次住院危险因素。结果:与HFrEF患者相比,HFpEF患者年龄、BMI、胆固醇、白蛋白更高,女性患者更多,心率、肌钙蛋白-I、脑钠肽(BNP)、胆红素、尿酸、水肿更少,住院时间较短、住院期间全因死亡率、入院后30d全因死亡率更低(均P<0.05)。与HFmrEF患者相比,HFpEF年龄更大、女性更多,三酰甘油、高密度脂蛋白更高,心率、肌钙蛋白-I、BNP、胆红素、尿酸、白细胞、尿素氮更低,住院时间更短(均P<0.05)。年龄、尿素氮、心率增高,住院时间延长为HFpEF患者全因死亡的独立危险因素。高龄、合并心房颤动多为≥65岁HFpEF患者出院1年内心衰再次住院的独立危险因素。结论:HFpEF患者近期、远期预后较差,HFpEF有不同于HFrEF、HFmrEF的临床特征,可能需要采取不同的防治方案。

Objective：To compare the clinical features and prognostic factors of heart failure with preserved ejection fraction（HFpEF）in our hospital.Method：The 523 patients with heart failure（HF）were divided into heart failure with reduced ejection fraction（HFrEF）,heart failure with mid-range ejection fraction（HFmrEF）,and HFpEF,according to the left ventricular ejection fraction.Their clinical characteristics and differences in prognostic indicators were compared.A total of 274 patients hospitalized with confirmed HFpEF,228 were≥65 years old and46 were65 years old.We analyzed the risk factors of heart failure hospitalization in patients with≥65 years old HFpEF.Result：Patients with HFpEF had higher age,BMI,cholesterol,albumin,more female patients,and lower heart rate,troponin-I,BNP,bilirubin,uric acid,edema,and shorter hospital stay than patients with HFrEF（all P〈0.05）,also all-cause mortality during hospitalization,and all-cause mortality at 30 days after admission were lower than patients with HFrEF（all P〈0.05）.Compared with patients with HFmrEF,HFpEF was older and more women,with higher triglyceride,high-density lipoprotein,heart rate,troponin-I,BNP,bilirubin,uric acid,white blood cells,and lower urea nitrogen,also hospital stay is shorter（all P〈0.05）.Increasing of age,urea nitrogen,heart rate,and prolonged hospital stay were independent risk factors for all-cause mortality in patients with HFpEF.Older age and history of atrial fibrillation are independent risk factors for HF hospitalization of HFpEF aged≥65 years after hospital discharge for one year late.Conclusion：The short-term and long-term prognosis of patients with HFpEF is poor.Compared with HFrEF and HFmrEF,HFpEF is different on the clinical features,and different preventive and therapeutic measures might be needed.