The Clinical Study Of Patients With Chronic Heart Failure With Preserved And Reduced Ejection Fraction

Objective:To investigate the difference of the clinical characteristics of patients with chronic heart failure with preserved ejection fraction (HF-PEF)、HF-PEF, borderline and reduced ejection fraction (HF-REF). Methods:Two hundred and sixty-eight patients with chronic heart failure in our hospital between January2011and December2013were analysed retrospectively. Of two hundred and sixty-eight patients with chronic heart failure, two hundred and forty-three patients were included in our study accorded with inclusion and exclusion criteria. Each patient received examinations of echocardiography)、electrocardiogram (ECG)/blood routine、blood biochemistry and hs-CRP. According to the different LVEF, the patients were divided into HF-PEF (LVEF≥50%)、HF-PEF, borderline (LVEF:41%-49%) and HF-REF (LVEF≤40%) The clinical data of patients were recorded and the clinical characteristics of HF-PEF、 HF-PEF, borderline and HF-REF were compared. Date analysis was performed by using the Statistical Package for Social Sciences (SPSS17.0). A value of P＜0.05was considered significant for all tests. Results:(1) Of243patients with chronic heart failure,62.14%(151) had HF-PEF, and the cardiac function of most patients with HF-PEF was NYHA class Ⅱ;16.87%(41) had HF-PEF, borderline and the cardiac function of most patients with HF-PEF, borderline was NYHA class Ⅲ;20.99%(51) had HF-REF, the cardiac function of most patients with HF-REF was NYHA class IV, and the cardiac function of patients with HF-REF was worst.(2) The proportion of female and hypertesion, the incidence of atrial fibrillation, and body mass index of patients with HF-PEF were higher than those of patients with HF-REF; but the proportion of male and coronary heart disease of patients with HF-REF were higher than those of patients with HF-PEF.(3) Pulmonary artery diameter, LVEDD, LVESD of patients with HF-REF were largerest, those of patients with HF-PEF were smallest, those of patients with HF-PEF, borderline were between HF-REF and HF-PEF (P＜0.05); the interventricular septum thickness of patients with HF-PEF were largerest, those of patients with HF-REF were smallest, those of patients with HF-PEF, borderline were between HF-PEF and HF-REF (P＜0.05). E/A ratio and left atrial diameter of patients with HF-PEF were smaller than those of HF-PEF, borderline or HF-REF (P＜0.05).(4) Heart rate of patients with HF-PEF is lower than that of patients with HF-PEF, borderline or HF-REF (P＜0.05). QRS wave of patients with HF-PEF is narrower than that of patients with HF-PEF, borderline or HF-REF (P＜0.05), QRS≤120ms was present in17.28%of all patients with chronic heart failure, and in7.95%of patients with HF-PEF,31.71%of patients with HF-PEF, borderline and33.33%of patients with HF-REF. The incidence of atrial fibrillation was higher in patients with HF-PEF(P＜0.05), but the incidence of ventricular arrhythmia and conduction block were higher in patients with HF-REF or HF-PEF, borderline (P＜0.05).(5) Serum creatinine, blood urea nitrogen, blood uric acid and hs-CRP of patients with HF-PEF were lower than those of patients with HF-PEF, borderline or HF-REF (P＜0.05); and total cholesterol in patients with HF-PEF or HF-PEF, borderline was higher than that of patients with HF-REF (P＜0.05), triglyceride of patients with HF-PEF was lower than that of patients with HF-PEF, borderline or HF-REF (P＜0.05), while serum sodium of patients with HF-PEF or HF-PEF, borderline was higher than that of patients with HF-REF (P＜0.05). Conclusion:Patients with HF-PEF were more likely to be female, and have a history of hypertension, higher incidence of atrial fibrillation, concentric hypertrophy, and severe diastolic dysfunction compared with patients with HF-REF; but patients with HF-REF were more likely to be male, and have a history of coronary heart disease, higher incidence of ventricular arrhythmia and conduction block, eccentric hypertrophy, and often concurrent with diastolic dysfunction compared with patients with HF-PEF. For patients with HF-PEF, borderline, some clinical characteristics appeared similar to those of patients with HF-PEF, the others appeared similar to those of patients with HF-REF.