Characteristic Analysis Of Echocardiography Of Heart Failure With Preserved Ejection Fraction

Background:Heart failure with preserved ejection fraction(HFpEF)patients have become the killer of cardiovascular diseases because of the rising morbidity and high mortality.Although the physiological mechanism of the cases is not clear,the main clinical manifestations are left ventricular filling capacity and left ventricular diastolic function impaired to varying degrees,which has a high degree of recognition of left ventricular diastolic dysfunction.Echocardiography has become a breakthrough in the diagnosis and treatment of ejection fraction retention heart failure because of its advantages of safety,noninvasive,simple,low cost and repeatable operation.The 2016 ASE/EACVI guidelines and standards simplified the diastolic function assessment process according to the expert consensus,recommended four key parameters,E,E/E ',LAVI and TR peak flow rate,to evaluate whether the left ventricular filling pressure was increased,and divided the left ventricular diastolic dysfunction into I,II and III levels.In this paper,the diagnostic value and advantages of echocardiography in HFpEF patients were discussed by analyzing the characteristics of echocardiography in HFpEF patients and left ventricular diastolic dysfunction grading.PART I: Heart failure with preserved ejection fraction:basic echocardiographic featuresAim:In this paper,the characteristics of echocardiography of three different heart failure patients were compared,and the relationship between the echocardiography and the heart function of nt-probnp and NYHA was discussed and analyzed.The characteristics of echocardiography of HFpEF were analyzed,and the diagnostic value and significance of echocardiography for HFpEF patients were discussed.Subjects and methods : The basic information,echocardiographic results,nt-probnp and NYHA heart function grades of 587 cases of inpatients with heart failure(including 372 cases of male and 215 cases of female,NYHA heart function grade ii-iv)were collected by retrospective analysis.According to the left ventricular ejection fraction(left ventricular ejection fraction,LVEF)divided 587 patients into HFpEF group(LVEF < 40%),HFmrEF group(LVEF40-49%)and HFrEF(LVEF50% or higher)three groups,the comparative analysis between the groups of echocardiography index,NT-proBNP,NYHA heart function classification and general information.Result: 1.There was no significant difference in age,creatinine,urea nitrogen,uric acid and sodium among the three groups of HFpEF,HFmrEF and HFrEF.There were significant differences in gender composition,etiology and NYHA cardiac function classification: theproportion of women in HFpEF group was significantly higher than that in HFmrEF group and HFrEF group;the proportion of high heart disease in HFpEF group was much higher than that in other two groups;the prevalence of dilated heart disease was mainly distributed in HFrEF group,and the incidence of coronary heart disease was in HFrEF group.The proportion of NYHA grade IV patients in HFrEF group was significantly higher than that in HFpEF group and HFmrEF group.The proportion of NYHA grade III patients in HFpEF,HFmrEF and HFrEF groups was 38%:24%:38%.2.The main echocardiographic features of HFpEF group were the elevation of LAVI,IVSd,LVPWd,E,E/e'(P < 0.05).The left ventricular diastolic function of three different types of heart failure patients was decreased in varying degrees,and their relative parameters(E,E/e',LAVI,TR peak velocity)were increased compared with the normal values of healthy people in Asia.Conclusion: The echocardiographic characteristics of HFpEF patients were mainly manifested as left atrial enlargement,left ventricular wall symmetry thickening,and decreased left ventricular diastolic function.Combined with nt-probnp and NYHA cardiac function grading,echocardiography can effectively identify and diagnose HFpEF,and echocardiography has unique advantages over other two methods in many aspects such as cardiac structure and cardiac function evaluation.PART II: Basic characteristics of echocardiography with different diastolic dysfunction grades in heart failure with preserved ejection fractionAim:To investigate the value of echocardiography in evaluating the severity of left ventricular diastolic dysfunction in patients with HFpEF by analyzing the characteristics of echocardiographic parameters and comparing the correlation among echocardiographic parameters,NT-proBNP and NYHA.Subjects and methods:According to ASE/EACVI guidelines of 2016 edition,the patients in HFpEF group were divided into three groups: left ventricular diastolic dysfunction I group(n=66,31 males and 35 females),left ventricular diastolic dysfunction II group(n=114,65 males and 49females),left ventricular diastolic dysfunction III group(n=37,19 males and 18 females).Figure indicators,NT-proBNP,NYHA cardiac function classification and general data were compared and analyzed.Result: 1.The level of uric acid increased with the increase of left ventricular diastolic dysfunction(P=0.020)in three different grades of left ventricular diastolic dysfunction.The levels of NT-proBNP and NYHA were positively correlated with the levels of left ventricular diastolic dysfunction in three groups of patients with different grades ofleft ventricular diastolic dysfunction(P < 0.05),while the levels of NT-proBNP in HFpEF patients were positively correlated with the levels of NYHA(P < 0.05).2.In HFpEF patients with different grades of left ventricular diastolic dysfunction,the main echocardiographic features were LAVI,E,E/e'and TR peak flow velocity increased with the increase of the grades of left ventricular diastolic dysfunction(P < 0.05),while the LVEF values of three groups of patients with different grades of left ventricular diastolic dysfunction were negatively correlated with the grades of left ventricular diastolic dysfunction(P = 0.000).Conclusion: 1.HFpEF patients with left ventricular diastolic dysfunction grading-related echocardiographic indicators and grading can effectively assess the severity of left ventricular diastolic dysfunction in HFpEF patients.2.There is a significant correlation between the left ventricular diastolic dysfunction classification of HFpEF patients and NT-proBNP,NYHA cardiac function classification.It can effectively assess the severity and cardiac function of left ventricular diastolic dysfunction in HFpEF patients.It is helpful to judge the severity and prognosis of HFpEF patients and guide clinical treatment more scientifically.