射血分数中间值心力衰竭患者生化特点及临床特征的分析

Analysis of biochemical characteristics and clinical characteristics of heart failure patients with intermediate ejection fraction

目的分析射血分数中间值心力衰竭患者的生化特点及临床特征。方法选取2012年6月至2017年6月首都医科大学附属北京安贞医院住院治疗、临床病例资料完整且出院第一诊断为心力衰竭的病例930例,根据左心室射血分数(left ventricular ejection fraction,LVEF)分为射血分数减低(LVEF<40%)心力衰竭组(射血分数减低心力衰竭组),射血分数中间值(LVEF 40%~49%)心力衰竭组(射血分数中间值心力衰竭组)和射血分数(LVEF≥50%)保留心力衰竭组(射血分数保留心力衰竭组)。记录急性心力衰竭与慢性稳定性心力衰竭例数。收集患者的一般资料[性别、年龄、体质量指数(body mass index,BMI)、收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)、心率(heart rate,HR)、NYHA分级]、实验室检查结果[脑钠肽(brain natriuretic peptide,BNP)]及超声心动图检查结果[左心室舒张末期内径(left ventricular end-diastolic diameter,LVEDD),左心房前后径(left atrium diameter,LAD),室间隔厚度(interventricular septum thickness,IVSD),左心室后壁厚度(left ventricular posterior wall thickness,LVPWT)]。结果射血分数中间值心力衰竭组的急性心力衰竭患者比例与射血分数减低心力衰竭组相似[38.0%(35/92)与45.4%(210/463),P>0.05],但明显高于射血分数保留心力衰竭组10.4%(39/375),P=0.000]。射血分数中间值心力衰竭组NYHA分级Ⅳ级患者比例低于射血分数减低心力衰竭组[10.9%(10/92)与24.6%(114/463),P=0.000],高于射血分数保留心力衰竭组2.9%(11/375),P=0.000。LAO、LVEDD射血分数减低心力衰竭组最大[(47±8)mm与(67.3±9.0)mm]、射血分数中间值心力衰竭组次之[(44±7)mm与(60.0±7.5)mm]、射血分数保留心力衰竭组最小[(42±7)mm与(41.7±6.1)mm],3组间差异有统计学意义(F=44.200,F=648.426,P均<0.05)。结论射血分数中间值心力衰竭患者部分生化指标及超声心动图特点介于射血分数减低心力衰竭与射血分数保留心力衰竭之间;射血分数中间值心力衰竭组与射血分数减低心力衰竭组左心室舒张末期内径明显增大,射血分数中间值心力衰竭组心室重构与射血分数减低心力衰竭患者相似,属于离心性重构。

Objective To analyze the biochemical characteristics and clinical characteristics of heart failure patients with intermediate ejection fraction.Methods From June 2012 to June 2017,nine hundred and thirty patients with heart failure who were hospitalized and treated in Beijing Anzhen Hospital were selected.According to left ventricular ejection fraction (LVEF),the patients were divided into heart failure with reduced left ventricular ejection fraction group (LVEF<40%),heart failure with midrange left ventricular ejection fraction group (LVEF 40%-49%) and heart failure with preserved left ventricular ejection fraction group (LVEF ≥ 50%).The number of cases of acute heart failure and chronic stable heart failure was recorded.The general patient information (gender,age,body mass index (BMI),systolic blood pressure (SBP),diastolic blood pressure (DBP),heart rate (HR),NYHA classification) laboratory test results (Brain Brain natriuretic peptide (BNP)) and echocardiography (left ventricular end-diastolic diameter (LVEDD),left atrium diameter (LAD),septal thickness (interventricular septum thickness,IVSD),left ventricle posterior wall thickness (LVPWT) were collected.Results The proportion of patients with acute heart failure in the midrange left ventricular ejection fraction heart failure was similar to the heart failure with reduced left ventricular ejection fraction (38.0% (35/92) vs.45.4% (210/463),P>0.05),but significantly higher than the heart failure with preserved left ventricular ejection fraction (38.0% (35/92) vs.10.4%(210/463),P=0.000).The proportion of NYHA class IV patients in the heart failure with midrange left ventricular ejection fraction was lower than the heart failure with reduced left ventricular ejection fraction(10.9%(10/92) vs.24.6%(114/463),P=0.000),and higher than the heart failure with preserved left ventricular ejection fraction (10.9 (10/92) % vs.2.9% (11/375),P =0.000).Left atrial diameter,left ventricular end diastolic diameter in the heart failure with reduced left ventricular ejection fraction were maximum ((47 ± 8) mm,(67.3 ± 9.0) mm),the heart failure with midrange left ventricular ejection fraction were medium ((44 ± 7) mm,(60.0 ± 7.5) mm),the heart failure with preserved left ventricular ejection fraction were minimum((42±7) mm,(41.7±6.1)mm),and the difference between the three groups was statistically significant (F =44.200,F =648.426,P < 0.05).Conclusion Some biochemical and echocardiographic features of heart failure with midrange left ventricular ejection fraction patients are located between heart failure with reduced left ventricular ejection fraction and heart failure with preserved left ventricular ejection fraction.The LVEDD is significantly increased in heart failure with midrange left ventricular ejection fraction and heart failure with reduced left ventricular ejection fraction group.The ventricular remodeling in heart failure with midrange left ventricular ejection fraction is similar to that of heart failure with reduced left ventricular ejection fraction.