| BackgroundAs the population continues to age,the risk of cardiovascular disease in the population is increasing,and the prevalence of heart failure is increasing year by year.In order to improve the understanding of patients with heart failure,the European Society of Cardiology(ESC)[1] proposed the median ejection fraction heart failure(HFmrEF)as a new category of heart failure in 2016.Heart failure patients with a left ventricular ejection fraction(LVEF)of 40-49% are also known as the "grey area" of heart failure.However,the clinical characteristics,treatment,and outcome of these "grey areas" have not yet been determined.In order to fully understand the clinical characteristics,risk factors,treatment,and prognosis of HFmrEF patients,we used retrospective analysis to study the clinical characteristics and 2-year prognosis of HFmrEF hospitalized patients.ObjectiveThe clinical data and prognostic factors of HFpEF,HFmrEF and HFrEF patients were analyzed to explore the clinical characteristics and prognostic factors of HFmrEF patients,to provide clinical reference for the prevention and treatment of patients with HFmrEF.MethodsWe collected 383 patients with HF(222 males and 161 females)hospitalized in the Fourth Affiliated Hospital of Xinxiang Medical College(Xinxiang Central Hospital)from September 2016 to september2017.They were divided into HFpEF group 165 cases,HFmrEF group 100 cases and HFrEF group 118 cases according to LVEF.The differences of general clinical data,laboratory test,echocardiographic,clinical medications,length of stay,cost,clinical cure rate,2-year survival rate,and prognostic factors among the three groups were compared.Results(1)The constitution ratio of three groups: HFrEF(30.81%),HFmrEF(26.11%),and HFpEF(43.08%).(2)The most HFmrEF patients was elderly compared with the HFrEF group,accompanied by high systolic and pulse pressure and low heart rate(P <0.025);a large proportion of patients with hypertension and cerebral infarction,combined with myocardial infarction and ventricular arrhythmia.The proportion of cardiomyopathy is small(P <0.025);the proportion of cardiac function class II and cardiac function class III(NYHA classification)is large,the proportion of cardiac function class IV(NYHA classification)is small(P <0.025);compared with HFpEF group,HFmrEF groups were younger,with lower systolic and pulse pressures(P <0.025),and the proportions of cardiac function II,cardiac function III,and cardiac function IV were all small(P <0.025);the proportion of dilated cardiomyopathy was large(P <0.025).(3)Laboratory examination: Compared with HFrEF group,HFmrEF hemoglobin,serum uric acid,NT-pro BNP levels were lower(P <0.05),HDL-C was higher.The level of NT-pro BNP was higher in HFmrEF(P <0.025)compared with HFpEF group.(4)Echocardiography: The HFmrEF group had smaller left atrium diameter,left ventricular end-diastolic diameter,left ventricular end-systolic diameter,and right ventricular diameter(P <0.025),and a lower proportion of pulmonary hypertension(P< 0.025),compared with the HFrEF group.The left ventricular end-diastolic diameter and left ventricular systolic inner diameter were larger in the HFmrEF(P <0.025)compared with the HFpEF group.(5)Clinical medication: Comparison of the three groups,the highest proportion of clopidogrel/tigrillo was found in the HFmrEF group(P <0.05).The application ratio of calcium antagonist(CCB)and digoxin was between the HFpEF and the HFrEF group,and the difference was statistically significant(P <0.025).The application of potassium application in the HFmrEF was lower than in the HFrEF group(P <0.025).(6)There were no significant differences in hospitalization days,hospitalization costs,clinical cure rate,two-year survival rate,and survival curves among three groups(P > 0.05).The proportion of hospitalization for non-cardiovascular factorswas higher in HFpEF group than in HFmrEF group(P<0.025).The hospitalization rate of cardiovascular factors in the HFrEF group was higher than in HFmrEF group(P<0.025).(7)All-cause mortality risk factors: low HGB,low diastolic pressure,and anteroposterior diameter widening of the left atrium for the first examination at admission were independent risk factors for all-cause death of HFmrEF(P <0.05).Age,renal insufficiency,elevated uric acid,and anteroposterior diameter widening of the left atrium were independent risk factors for HFpEF mortality(P <0.05).Low systolic blood pressure,increased uric acid,pulmonary infection and no ?-blocker application were independent risk factors for all-cause mortality of HFrEF(P <0.05).Conclusion1.HFmrEF accounts for a significant proportion of total heart failure(26.11%),was more elderly male patients with coronary heart disease,hypertension,pulmonary infection,atrial fibrillation,etc.,and the heart function is better;2.NT-proBNP is higher in the HFmrEF group,the left atrium and ventricle are enlarged,PAP is increased,the laboratory and echocardiographic results are mostly similar to the HFpEF group,and antiplatelet drugs are most used in the HFmrEF group;3.In the prognosis,mortality rates were similar in the three groups.the independent risk factors for 2 years of all-cause death were the Left atrial enlargement,low diastolic depression and low hemoglobin in the HFmrEF group. |
PDF Full Text Request