Clinicai Characteristics And Outcomes Of Heart Failure Patients With Mid-range Ejection Fraction

Aim : To compare the clinical characteristics and outcomes of hospital patients with HFmr EF(Heart failure with mid-range ejection fraction),HFr EF(Heart failure with reduced ejection fraction),HFp EF(Heart failure with preserved ejection fraction),in order to understand the the clinical characteristics and outcomes of heart failure patients with mid-range ejection fraction.Subjects and methods : In this study,a prospective study was conducted with 344 heart failure patients hospitalized in the First Affiliated Hospital of University of South China from February to December 2017.The patients were excluded with unstable vital signs /acute myocardial infarction /myocarditis /incomplete clinical data.They were stratified according to LVEF(Left ventricular ejection fraction)as follows: HFr EF,LVEF< 40%;HFmr EF,LVEF40%-49%;and HFp EF,LVEF>50%.The clinical data were collected,including age,gender,NYHA functional class,primary causes of heart failure(coronary heart disease,hypertensive heart disease,dilated cardiomyopathy,valvular heart disease,hypertrophic cardiomyopathy,arrhythmogenic cardiomyopathy,congenital heart disease,others),comorbidities(anemia,atrial fibrillation,chronic obstructive pulmonary disease,hypertension,stroke,chronic renal insufficiency,diabetes,sleep apnea-hypopnea syndrome),laboratory results(NLR,N-terminal B brain natriuretic peptide NT-pro BNP),echocardiography(left atrial diameter LAD,left ventricular end diastolic diameter LVEDd).The median follow-up time for all patients with heart failure was 6 months(IQR 2-9).Result: A total of 344 patients were enrolled in the study.Among the study participants,151(44%)had HFr EF,69(20%)HFmr EF,and 124(36%)HFp EF.(1)The clinical characteristics of 3 group patients: Mean age of HFmr EF is(67.46 ± 11.07)years,older than HFr EF,and HFmr EF has greater female,which is similar to patients of HFp EF.In NYHA functional classification,there was no significant difference between the HFmr EF group and the other two groups.In aspect of echocardiography,the average LAD in HFmr EF was(42.03±11.24)mm.There was no significant difference between the 3 groups.The average LVEDd in HFmr EF was(56.22±8.56)mm,which was higher than HFp EF,and lower than HFr EF.In aspect of laboratory results,the median N-terminal pro-B type natriuretic peptide(NT-pro BNP)in HFmr EF was 4723(2997,8922),which was higher than HFp EF,and lower than HFr EF.There was no significant difference of NLR in the 3 groups.(2)In aspect of etiology,compared with HFp EF,patients in the HFmr EF group were less likely to have hypertension heart disease,valvular heart disease,and more likely to have coronary heart disease,dilated cardiomyopathy.There was no significant different between HFmr EF and HFr EF.(3)In aspect of comorbidities,there was no significant difference between the HFmr EF and other two groups.The HFp EF was more likely to have anemia and atrial fibrillation than in HFr EF group.(4)In aspect of pharmacological treatment on discharge,compared with HFp EF,the patients in HFmr EF were given more angiotensin-converting enzyme inhibitors,Angiotensin receptor blocker(ACEI/ARB),beta blockers,aldosterone antagonists and diuretics,which was similar to HFr EF.(5)In aspect of outcomes,the median follow-up was 6 months(IQR2-9).there was no significant difference between 3 group in cardiovascular endpoint events.And there was no significant difference between 3group in all cause mortality/heart failure rehospitalization..Conclusion: According to the clinical characteristics,HFmr EF was similar to the HFp EF group.The outcomes was no significantly differences among the 3 groups.