| BackgroundChronic systolic heart failure (CSHF), a worldwide health problem, is the terminal state of all precursory heart disease and one of the most important disease which cause hospitalization as well as death. Although during the last decades, there has been great progress in diagnosis and therapy of CSHF, incidence and prevalence of this disease are increasing and the death rate is still on a high level. One benefit of the progress in treatment of CSHF is that its cardiac death has been diminished significantly, meanwhile, the role of non-cardiac death is more and more important. Treating these comorbidity together with heart failure itself is of special importance in improvement of prognosis. Although the multiorgan impairment in development of CSHF is already a well-known topic, and the relationship between CSHF and single-organ impairment has been studied a lot, few evidence are reported on relationship of CSHF and multiorgan impairment, especicially its important contribution to clinical progress, short-term, and even long-term prognosis of CSHF. This study aims to provide affirmative evidence to the multiorgan interactions in development of CSHF and to demonstrate their effect on short-term outcome of inpatients with CSHF.Methods Data collectionWe reviewed the medical records of patients with a discharge diagnosis of CSHF at the Department of Cardiology, Qilu Hospital of Shandong University (Shandong, China) during January1,2000and May31,2011. Patients who aged≥18years old and had insufficient left ventricular function (left ventricular ejection fraction<50%) were included. For those who had admitted to hospital more than one time, only1randomly selected hospitalization was included in the sample.Data analysis1. baseline data analysisBaseline characteristics was analyzed in3dimentions including age(age1,higher-age group,for≥65years,age2,lower-age group,for<65years), NYHA classifications(NYHA1for grade IV,NYHA2for NYHA grade Ⅱ orⅢ), and etiology (ischemic heart disease vs non-ischemic heart disease). For each dimention, continuous data were presented as mean±SD or median (interquartile range) and compared using two-tailed unpaired Student t test or Kolmogorov-Smirnov Z test as appropriate.Categorical variables were presented as frequencies (percentages) and compared using Pearson Chi-square test or Fisher’s exact test as apropriate.Combined with speculative knowledge, a theoretical model was constructed. To explore the latent structure, exploratory factor analysis (EFA) was used to extract the latent factors from baseline characteristics previously. Structural equation modeling (SEM), an inclusive statistical modeling approach for testing hypotheses about relationships among measured and latent variables, was then used to test our theoretical model. Because of the non-normal distribution, multicollinearity of the data, the partial least square (PLS) algorithm was chosen to set up SEM, named as PLS path modeling (PLS-PM). Afterward, we conduct the binary logistic regression (BLR) to investigate predictors of in-hospital mortality, so as to explore whether or not the risk factors that affect short-term outcome of CSHF was consistent with the results from PLS-PM.Results1.Baseline data analysisOf the890individuals discharged with CSHF,69%were men and43.1%were≥65years.65.8%of the patients took β-blockers while86.3%took angiotensin-converting enzyme inhibitors or angiotensin receptor blockers.2.PLS path modelingAge was the most significant risk factor and coronary heart disease was the primary aetiology of CSHF. NYHA classification was the most important indicator of heart function in illness assessing and therapy deciding during hospitalization.The PLS path model showed obvious interactions between heart function and multisystemic statements. Worsening of heart function has significant effect on multiorgan statement represented by hepatic and renal function (β=0.24, p<0.001), and vice versa, basic statement has abvious protective effect on heart function (β=-0.31,p<0.001), reduction of indicators in this block can cause elevation in NYHA classification, ACC/AHA stage and reduction in left ventricular ejection fraction. PLS path model shows a vicious circle between worsening heart function and multiorgan impairment. 3.Multivariate logistic analysisOf all patients,29died during hospitalization, the in-hospital mortality was3.3%. Serum natrium, aspartate aminotransferase and relative lymphocyte count were associated with In-hospital death independently in multivariate analysis.ConclusionInteractions between CSHF and multisystemic impairment play a critical role in the clinical process and treatment of CSHF as well as its very short-term prognosis. Comprehensive understanding of CSHF and affirmative measures of maintaining stable basal systemic state are of vital importance in the clinical treatment of CSHF. |
