Prediction Factors Of Stable Coronary Heart Disease With Ejection Fraction Preserved Heart Failure

Objective:To explore the risk factors of stable coronary heart disease(SCAD)with heart failure with preserved ejection fraction(HFpEF)and its possible mechanism.Methods: Collect patients diagnosed with SCAD from January 2016 to December 2019 in the First Cardiology Department of our hospital.,Patients with SCAD combined with HFpEF(group A)and simple SCAD(B group)were screened.Data of the two groups were collected,including age,gender,past history,body mass index,echocardiographic index,plasma homocysteine(Hcy),troponin I,N-terminal B-type natriuretic peptide precursor,glycosylated hemoglobin,hemoglobin and renal function related indicators.Results:Compared with patients with SCAD alone,the median age of patients with SCAD and HFpEF was higher(64(56-70)years VS 59(51-64)years P=0.008),and the proportion of diabetes history was higher(16.9% VS 36.4%,P=0.019).The median level of interventricular septum(IVS)in SCAD with HFPEF group(13.8(12.4-14.4)mm)was higher than that in simple SCAD group(10.5(10.25-10.75)mm)(P = 0.0047).The median level of velocity ratio of E peak to A peak of mitral valve(E/A)in SCAD with HFPEF group(0.78(0.67-0.93))was lower than that in simple SCAD(1(0.86-1.25))(P < 0.001).The median level of homocys teine(Hcy)(15.76(13.45-21.06)? mol/L vs13.41(11.28-15.89)?mol/L),Troponin I(c Tn I)(0.01(0.01-0.07)?g/L VS 0.01(0.01-0.01)?g/L,P=0.02),Cystatin C(Cys C)(1.28(1.04-1.46))mg/L VS 0.98(0.88-1.12)mg/L,P<0.001),N-terminal pro-B-type natriuretic peptide(NT-pro BNP)(516.70(132.20-516.70)pg/ml VS 46.34(24.55-78.60)pg/ml,P<0.001),glycosylated hemoglobin(Hb A1c)(6.00(5.65-7.10)% vs 5.65(5.40-6.00)%,P=0.002),were higher in HFpEFpatients with SCAD than those in simple SCAD patients,hemoglobin(Hb)(135.65 ± 16.80)g/L VS(141.51 ± 12.34)g/L,P=0.038)and median glomerular filtration rate(89.61(75.11-97.43)vs 97.34(87.58-104.36),P=0.003)(unit: min·1.73m2)were lower.The Logistic analysis found that Low hemoglobin(OR=0.948,P=0.048),high homocysteine(HHcy)(OR=1.290,P=0.005)significantly increased the risk of HFPEF in SCAD patients.Further study showed that the ratio of microalbumin to creatinine was 12.5(6.20-30.90)and7.2(4.03-10.88),P=0.002,respectively,and Hcy was positively correlated with the ratio of microalbumin to creatinine(r=0.267,P=0.009).Conclusion:HHcy might be an important risk factor for HFpEF in patients with SCAD,and probably have predictive value for HFpEF in patients with SCAD,and the mechanism of Hcy causing HFpEF may be closely related to the microvascular dysfunction.