The Analysis Of Clinical Characteristics And Prognosis Of Hospitalized Patients With Heart Failure With Mid-range Ejection Fraction

ObjectiveTo analysis the difference of the clinical characteristics and prognostic factors of patients with heart failure with preserved ejection fraction(HFp EF)?mid-range ejection fraction(HFmr EF)and reduced ejection fraction(HFr EF),to deepen our understanding of HFmr EF,and provide some reference basis for provention strategies of HFmr EF.MethodsWe retrospectively analyzed 620 cases of heart failure patients who underwent cardiology from Henan Provincial People's Hospital from January 2014 to December 2015.Of 620 patients with heart failure,560 patients were included in our study accorded with inclusion and exclusion criteria.All of the patients received the examinations of cardiac ultrasound,dynamic electrocardiogram,blood biochemical detection.The research object were divided into three group:HFp EF(LVEF?50%)?HFmr EF(40% ? LVEF ? 49%)and HFr EF(LVEF <40%)according to the different LVEF.We follow up the three group patients by telephone in in January 2017 to February 2017.The study endpoint was all-cause mortality.The clinical data and the prognosis of the patients were recorded and compared with HFp EF,HFmr EF and HFr EF patients with sex,age,heart structure and function,blood biochemical and the prognosis factors differences.Data processing SPSS17.0 statistical software,the application of KS to do the normality test,metering data obey the normal distribution or approximate normal distribution of the standard deviation of the mean soil;consistent with the normal distribution,and the variance is homogeneous,then the three Comparison between groups using one-way ANOVA,and then comparing the two groups,the comparison between the two groups using LSD test;do not meet the normal distribution,and the variance is not the same,using the rank sum test(Kmskal-Wallis test);Count data used as a percentage,said the comparison between groups using cni-qure test.Survival analysis using Kaplan-Meier survival curve.Multivariate analysis using COX proportional risk regression model.When P <0.05,the difference was statistically significant.In count data,the comparison between two groups,when P<0.025,the difference was statistically.ResultIn this study,560 patients with heart failure were included,including 326 males(58%)and 234 females(42%)with an average age of 61 ± 14,274 patients(49%)with HFr EF,129 patients(23%)with HFmr EF,157 patients with HFp EF(28%).Of the 560 patients,509 were followed up,51 were lost,lost rate is 9%,and the median follow-up was 22(1-45)months,of which 79 patients died.(1)Comparised with HFr EF group,patients with HFmr EF had a higher proportion of female,diabetes and anamia and a lower proportion of dilated cardiomyopathy and NYHA class IV patients(P<0.025).The admission systolic blood pressure of patients with HFmr EF was higher and the admission heart rate was slower than patients with HFr EF(P<0.05).Compared with HFp EF group,HFmr EF group had a smaller systolic blood pressure(P <0.05),and the proportion of coronary heart disease and dilated cardiomyopathy was higher and the proportion of atrial fibrillation was smaller(P <0.025);(2)In the laboratory inspection,the number of erythrocytes and the level of ALT,patients with HFmr EF were higher than HFp EF patients(P<0.05).In the level of erythrocytes,total bilirubin and direct bilirubin,blood uric acid,NT-pro BNP,HFr EF patients were higher than HFp EF patients(P<0.05).(3)Cardiac structure and function,left ventricle end diastolic dimension,left atrial diameter,right ventricular end-diastolic dimension were smaller than those of patients with HFr EF(P<0.05),the proportion of puimonary hypertension and left ventricular wall motion diffuse weakened of patients with HFmr EF were smaller than those of patients with HFr EF,but the proportion of left ventricular segmental wall motion abnormality of patients with HFmr EF were smaller(P <0.025).HFmr EF compared with HFp EF,the left ventricle end diastolic dimension was larger(P<0.05).The proportion of left ventricular wall motion diffuse weakened was higher(P <0.025).(4)In clinical medication,HFmr EF compared with HFr EF,the use rate of clopidogrel,statin is higher,the use rate of digoxin,spironolactone was lower(P <0.025);Compared with HFp EF,digoxin,? receptor blockers utilization rate was higher.While the use rate of calcium antagonists was lower(P <0.025).(5)In the prognosis,mortality rates were similar in patients with HFmr EF?HFr EF and HFp EF(P=0.913).(6)Predictors of mortality vary across HFp EF,HFr EF and HFm EF patients: In patients with HFr EF,presence of coronary heart disease,hyponatremia,atrial fibrillation,unuse of ?-blockers were associated with increased all-cause mortality.In HFmr EF,coronary heart disease,left ventricle end diastolic dimension,anemia significantly predicted mortality.hyponatremia,age,low albumin and hemoglobin were significant predictors of mortality among HFp EF patients(P <0.05).Conclusion 1.HFmr EF patients account for a significant proportion of people with heart failure(23%);2.HFmr EF group was more female,diabetes mellitus,anemia,coronary heart disease,the admission systolic pressure was higher,heart rate was slower,heart function is better,the incidence of atrial fibrillation was lower;In the laboratory and echocardiographic features,HFmr EF patients were between HFr EF patients and HFp EF patients,and more similar to HFp EF patients.3.In the prognosis,mortality rates were similar in patients with HFmr EF?HFr EF and HFp EF.But the predictors of mortality vary across HFp EF,HFr EF and HFm EF patients,in HFmr EF,coronary heart disease,left ventricle end diastolic dimension,anemia significantly predicted mortality.