| Backgrounds and Objectives Echocardiography is commonly used for assessment of cardiac function clinically, where left ventricular ejection fraction(LVEF) is the most important parameter of systolic function but not the unique factor related to the symptom of heart failure. The present study aimed to investigate the predictive factors of NYHA Class in patients with reduced LVEF by analyzing the relationships between echocardiographic measurements and NYHA Class.Methods Data including basic information, echocardiography parameters, NT-pro BNP and discharge diagnosis of 260 inpatients with reduced LVEF from department of cardiology of our hospital were analyzed retrospectively, among whom 180 were sinus rhythm(SR) and 80 were atrial fibrillation(Af). According to NYHA class, 64 were classified as asymptomatic reduced EF(NYHA class I, AREF), and 196 were heart failure with reduced EF(NYHA class II~IV, HFREF). The main echocardiographic parameters collected included left atrial diameter(LAD), left ventricular end diastolic diameter(LVDd), LVEF, diastolic mitral inflow E, A and E/A ratio, mitral annulus E? and A? and E/E? ratio, systolic pulmonary artery pressure(SPAP), left ventricular filling pressure(LVFP). Spearman rank correlation and logistic regression analysis were performed.Results 1. HFREF patients had a considerable higher prevalence of dilated cardiomyopathies compared with AREF patients. There were no significant differences in age, sex, coronary artery disease, hypertension, diabetes mellitus, dyslipidemia between two groups. 2. HFREF patients had increased LAD(4.69±0.71 versus 4.05±0.56;P<0.05), LVDd(6.32±0.87 versus 5.71±0.61;P<0.05),SPAP(42.86± 12.77 versus 31.89 ± 8.16; P<0.05), E/E? ratio(15.21±6.82 versus 12.65±6.00;P<0.05), higher prevalence of increased LVFP(81.6% versus 35.9%;P<0.05)and lower LVEF(32.71±10.00 versus 41.70±6.72;P<0.05), compared with AREF patients. 3. LAD, LVDd, LVEF, E, E/E? ratio, SPAP, NT-pro BNP were all significantly correlated with NYHA class, among which LAD, LVEF, SPAP, NT-pro BNP had closer correlations( r-value 0.43,-0.41,0.37,0.65, respectively). 4. By multiple logistic regression analysis, LAD, LVEF, LVFP, were independently associated with symptoms of heart failure among the commonly used echocardiographic parameters(OR was 3.028,2.543, 3.564, respectively), so was NT-pro BNP(OR=6.988). But for patients with Af, LVEF, LVFP rather than NT-pro BNP emerged as independent predictors of heart failure symptoms(OR was 13.549, 82.963, respectively). Multiple logistic regression analysis regarding increased LVFP showed LAD, E, E/E? ratio, E/A ratio were independent predictors of increased LVFP in patients with SR(OR was 2.741, 8.728, 22.025, 5.041,respectively), But for patients with Af, E/ E? ratio was the only independent predictors of increased LVFP.Conclusions Echocardiographic parameters were valuable for prediction of NYHA Class and increased LVFP in patients with LVEF less than 50% and was helpful for auxiliary diagnosis and comprehensive evaluation of heart failure clinically. 1. Among all conventional echocardiographic parameters, LAD, LVEF, LVFP were independently associated with NYHA class, among which LVFP was most powerful indicator for NYHA Class in patients with SR, but LAD had no relation to NYHA class in patients with Af. 2. LAD, E, E/E? ratio, E/A ratio were independent predictors of increased LVFP in patients with SR, but only E/E? was related to increased LVFP for patients with Af. 3. The predictive value of Doppler-derived LVFP for NYHA class were higher than NT-pro BNP in patients with Af, while LVFP had lower capability than NT-pro BNP for predicting NYHA class in patients with SR. |
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