不同射血分数心力衰竭患者临床特征和预后分析

Clinical Characteristics and Prognosis in Patients with Heart Failure and Different Ejection Fraction

目的:探讨不同射血分数(EF)心衰患者的临床特征及预后,为射血分数中间值的心力衰竭(HFmrEF)患者的临床诊治提供一定参考。方法:对安溪县医院心内科529例HF出院患者进行回顾性分析,根据EF分为射血分数降低的心力衰竭HFrEF组(LVEF<40%,n=82)、HFmrEF组(40%≤LVEF<50%,n=102)和射血分数保留的心力衰竭(HFpEF)组(LVEF≥50%,n=345)。收集三组患者基线资料、实验室检查指标及超声心动图检查指标,并进行中位数14个月的随访,记录患者全因死亡情况和再入院时间。结果:(1)HFmrEF占19.3%,HFpEF占66.0%,HFrEF占14.7%。与HFrEF相比,HFmrEF组年龄较大,扩张型心肌病(DCM)比例较低、房颤比例高,左室内径(LVEDD)较短,左室舒张末期容积(LVEDV)较小,左室短轴缩短率(FS)较高(P均<0.05);而在性别、糖尿病、NT-proBNP、肌钙蛋白(cTnI)、尿酸(UA)、总胆红素(TBIL)、收缩压(SBP)、心率(HR)上无统计学差异。而与HFpEF相比,HFmrEF组患者年龄较小,冠心病(CHD)、糖尿病比例低,DCM比例高、高血压病比例低、NYHA分级较高,SBP较低;血液指标中cTnI、UA、NT-proBNP、TBIL较高;LVEDD、LVEDV较高,FS较低(P均<0.05)。表现为从HFrEF到HFmrEF到HFpEF,年龄、CHD、高血压病比例及FS进行性升高,而DCM比例、LVEDV、LVEDD再发事件逐渐变小(P<0.05)。(2)Spearman相关分析显示,心力衰竭分型与年龄(r=0.290,P=0.000)、FS(r=0.495,P=0.000)、SBP(r=0.255,P=0.000)正相关,与NT-proBNP(r=-0.264,P=0.000)、UA(r=-0.194,P=0.000)、LVEDV(r=-0.567,P=0.000)、LVEDD(r=-0.642,P=0.000)负相关。结论:HFmrEF患者的临床特征与HFrEF相似,其心力衰竭严重程度及左心室重构程度介于HFrEF与HFpEF之间,预后较HFpEF患者差。

Objective:To analyze the clinical characteristics and prognosis in patients with heart failure(HF)and different ejection fraction(EF),so as to provide some reference for the clinical diagnosis and treatment to HF with mid-range EF(HFmrEF).Methods:529 hopitalitalized HF patients from Anxi County Hospital were retrospectively analyzed in this study.All patients were divided into HF with reduced EF(HFrEF)group(LVEF<40%,n=82),HFmrEF group(40%≤LVEF<50%,n=102)and HF with preserved EF(HFpEF)group(LVEF≥50%,n=345).The baseline information,laboratory examination indexes and echocardiography indexes were collected in the three groups.All patients discharged were followed up for 14 months,the clinical end-point were all-cause death and HF readmission.Results:(1)HFmrEF accounted for 19.3%,HFpEF accounted for 66.0%,HFrEF accounted for 14.7%.Compared with HFrEF group,HFmrEF group had older age,lower proportion of Dilated cardiomyopathy(DCM)and higher proportion of Atrial fibrillation,smaller left ventricular diameter(LVEDD),smaller left ventricular end-diastolic volume(LVEDV),and higher Left ventricular fractional shortening(FS)(all P<0.05).However,there were no significant differences in gender,diabetes,NT-proBNP,troponin(cTnI),Uric acid(UA),Total bilirubin(TBIL),Systolic blood pressure(SBP),and heart rate(HR).Compared with HFpEF group,HFmrEF group had younger age,lower proportion of coronary heart disease(CHD)and diabetes,higher proportion of DCM,lower proportion of hypertension,higher NYHA grade,and lower SBP,higher UA,cTnI,NT-proBNP and TBIL,higher LVEDD and LVEDV,lower FS(all P<0.05).From HFrEF to HFmrEF to HFpEF,age,the proportion of CHD and hypertension,FS gradually increased,the proportion of DCM,LVEDV,LVEDD and recurrence gradually decreased(P<0.05).(2)Spearman rank correlation analysis showed that the heart failure classification was positively associated with age(r=0.290,P=0.000),FS(r=0.495,P=0.000),SBP(r=0.255,P=0.000),and negatively correlated with NT-proBNP(r=-0.264,P=0.000),UA(r=-0.194,P=0.000),LVEDV(r=-0.567,P=0.000),LVEDD(r=-0.642,P=0.000).Conclusion:The clinical features and clinical end-point of HFmrEF patients are similar to those of HFrEF patients,the severity of HF and left ventricular remodeling of HFmrEF patients are between HFrEF and HFpEF,the prognosis is slightly worse than that of HFpEF.