ST段抬高型心肌梗死伴射血分数中间值心力衰竭的临床特征分析

Clinical characteristics of ST-segment elevation myocardial infarction with mid-range left ventricular ejection fraction

目的研究分析ST段抬高型心肌梗死(STEMI)患者经直接经皮冠状动脉粥样硬化性心脏病(PCI)后伴发射血分数中间值心力衰竭(HFmr EF)的临床特征及住院结局。方法选取2015年6月至2018年6月于武汉大学人民医院心内科收治的STEMI经直接PCI后伴发心力衰竭的患者286例为研究对象,入院3 d内行超声心动图检查,按照左心室射血分数(LVEF)将患者分为射血分数减少的心力衰竭组(HFr EF组,n=32)、射血分数中间值的心力衰竭组(HFmr EF组,n=84)、射血分数保留的心力衰竭组(HFp EF组,n=170)。搜集患者的一般临床资料及生化检验结果等,分析比较各组患者临床特征。结果本研究中,HFr EF组占11.2%,HFmr EF组占29.4%,HFp EF组占59.4%。与HFr EF组相比,HFmr EF组的患者年龄偏小,女性较少,B型钠尿肽(BNP)水平较低,左房直径较短;在并发症方面,患者伴有室壁瘤、休克、乳头肌功能失调、室性心律失常、急性肾衰和死亡的比例较低,差异均有统计学意义(P<0.05)。与HFp EF组相比,HFmr EF组的患者呼吸、心率偏快,冠状动脉狭窄数量、左前降支狭窄程度更重,支架置入数量较少;在并发症方面,患者伴乳头肌功能失调、室性心律失常、急性肾衰的发生率较高,差异均有统计学意义(P<0.05)。结论 HFmr EF作为心力衰竭的一个独立类型,其临床特征介于HFr EF和HFp EF之间,在不同方面各有倾斜;在住院全因死亡率上,HFmr EF组与HFp EF相近,低于Hfr EF组。

Objective To investigate the clinical features and hospital outcomes of patients with ST-segment elevation myocardial infarction (STEMI) with median heart failure (HFmrEF) after direct PCI. Methods A total of 286 of patients with heart failure with STEMI accompanied by the median blood score were included from June 2015 to June 2018, 32 cases in the HFrEF group, 84 cases in the HFmrEF group and 170 cases in the HFpEF group. Demographic data, clinical features, laboratory testing data and coronary angiography results were compared. Results In this study, the HFrEF group accounted for 11.2%, the HFmrEF group accounted for 29.4%, and the HFpEF group accounted for 59.4%. Compared with the HFrEF group, patients in the HFmrEF group were younger, fewer women, lower B-type natriuretic peptide (BNP), and shorter left atrial diameter. In terms of complications, the proportion of patients with ventricular aneurysm, shock, papillary muscle dysfunction, ventricular arrhythmia, acute renal failure and death was lower, and the difference was statistically significant (P<0.05). Compared with the HFpEF group, patients in the HFmrEF group had faster breathing and heart rate, and the number of coronary stenosis, stenosis of the left anterior descending artery was more severe, and the number of stent placement was less. In terms of complications, the incidence of papillary muscle dysfunction, ventricular arrhythmia, and acute renal failure was higher in the patients, and the difference was statistically significant (P<0.05). Conclusion As an independent type of heart failure, HFmrEF has clinical features between HFrEF and HFpEF, and has different inclinations in different aspects. In hospitalized all-cause mortality, HFmrEF group is similar to HFpEF and lower than HFrEF group.