Effect Of Coronary Artery Disease On Clinical Features And Prognosis Of Patients With Different Types Of Heart Failure

Objective: As the increasing survival rate after acute myocardial infarction and the weakening effect of hypertension and valvular heart disease on heart failure,coronary artery disease(CAD)gradually becomes the most important risk factor for the development of heart failure.Previous studies have paid more attention to the pathogenic effect of CAD on the heart failure with reduced left ventricular ejection fraction(HFr EF;LVEF <40%).However,there are relatively few studies on the pathogenic and prognostic significance of CAD for the heart failure with preserved left ventricular ejection fraction(HFpEF;LVEF?50%).The left ventricular ejection fraction from 40% to 49% of chronic heart failure was defined as the heart failure with mid-range ejection fraction in the 2016 European Society of Cardiology(ESC)about guidelines for the diagnosis and treatment of acute and chronic heart failure.With the redefinition of heart failure classification in domestic and international up to date guidelines,the pathogenic and prognostic significance of CAD in various types of heart failure remains to be determined.The aim of this study was to investigate the effects of CAD on the clinical features and prognosis of HFr EF,HFmrEF and HFpEF.Methods: Data of patients with heart failure as the main diagnosis and NYHA cardiac function classification II-IV hospitalized in 9 tertiary hospitals in Tianjin from March 2014 to February 2016 were collected.A total of 1520 cases of heart failure patients with complete clinical data and follow-up of 2 years end point were included.According to LVEF,it is divided into three groups: HFr EF,HFmrEF and HFpEF.Each group is divided into two subgroups according to whether or not to merge CAD,among them,197 patients in the HFr EF No CAD group,435 patients in the HFr EF With CAD group,63 patients in the HFmrEF No CAD group,367 patients in the HFmrEF With CAD group,72 patients in the HFpEF No CAD group,and 386 patients in the HFpEF With CAD group.In order to study the influence of CAD on the prognosis of different types of heart failure,we analyzed the risk of coronary heart disease in different types of heart failure,compare the clinical features,comorbidities,and drug treatment among different subtypes of heart failure,and follow up for 2 years for all patients with heart failure,and record all-cause death,cardiovascular death,hospitalization for acute coronary syndrome and re-hospitalization of heart failure.Results:1.The effect of CAD on the clinical features of different types of heart failure: the ratios of HFr EF,HFmrEF and HFpEF combined with CAD were 68.8%,85.3% and 84.3%,respectively(P<0.05).The prevalence of CAD in HFmrEF and HFpEF was similar(P>0.05),and significantly higher than the prevalence of CAD in HFr EF(P<0.05).Compared with the patients of No CAD subgroup,patients of the three With CAD subgroups were older and had higher NT-pro BNP levels,with a higher rate of hypertension,diabetes,and cerebrovascular disease,and a lower rate of atrial fibrillation.,more use of antiplatelet and nitrate drugs,less use of digitalis drugs(P <0.05).There was no difference in the application of ACEI/ARB,?-blockers,aldosterone receptor antagonists,diuretics,and calcium channel blockers between No CAD and With CAD subgroups of three types heart failure(p>0.05).2.Relationship between heart failure type and CAD: HFr EF has a lower risk of CAD after multivariate adjustment(HFr EF vs HFmrEF: RR=0.389,95% CI 0.281-0.540;HFr EF vs HFpEF: RR=0.408,95%)CI 0.298-0.560);there was no difference in the risk of CAD between HFmrEF and HFpEF(HFmrEF vs HFpEF: RR=1.029,95% CI 0.703-1.057).3.The effect of CAD on the prognosis of different types of heart failure: the cardiovascular events rate of the With CAD subgroup in the three heart failure groups were higher than the NO CAD subgroup(P<0.05),in the HFr EF group,the all-cause mortality of the With CAD subgroup was higher than that of the NO CAD subgroup(P<0.05).After multivariate adjustment,CAD increased the risk of cardiovascular events in all three types of heart failure(HR: HFr EF 1.725,95% CI 1.325-2.246;HFmrEF 1.815,95% CI 1.144-2.879);HFpEF 1.900,95% CI 1.218-2.963),CAD increased the risk of all-cause mortality in the HFr EF group(HR=1.631,95% CI1.119-2.377).Conclusion:1.Patients with HFmrEF and HFpEF have higher prevalence and risk of CAD than patients with HFr EF;2,patients with heart failure with CAD tend to be more serious,with more comorbidities and cardiovascular risk factors;3.CAD is associated with an increased risk of cardiovascular events in all types of heart failure and increases the risk of all-cause mortality of HFr EF.In summary,CAD is an important factor influencing the clinical features and prognosis of patients with various types of heart failure.Therefore,it is necessary to carefully identify the presence of CAD in patients with heart failure and conduct targeted interventions to improve the poor prognosis of patients with heart failure.