Risk Factors And Clinical Features Of Heart Failure With Preserved Ejection Fraction Combined With Pulmonary Hypertension

Objective:To explore the risk factors and clinical features of heart failure with preserved ejection fraction(HFpEF)combined with pulmonary hypertension,this will enable clinicians to have a deeper understanding of the disease and further explore the diagnosis and treatment basis of HFpEF combined with pulmonary hypertension.Methods:According to the inclusion and exclusion criteria,a retrospective study was conducted to collect 123 patients with HFpEF admitted to the first department of geriatrics of our hospital from May 2009 to December 2012,and 93 cases of normal controls in the same period.Basic data(such as gender,age,past medical history,and current symptoms,etc.);hematological indicators(such as blood routine,blood biochemistry,thyroid function,hematopoietic indicators,etc.);cardiac color doppler ultrasound(such as related indicators of left heart and right heart,etc.)were collected from all subjects.Chi-square test,Fisher's exact probability test,independent sample t test,Wilcoxon symbolic rank sum test and binary logistic regression were used to observe the risk factors of pulmonary hypertension in the HFpEF population.Chi-square test,Fisher's exact probability test,single-factor ANOVA analysis and Kruskal-Wallis H tests in nonparametric tests to observe the clinical features of HFpEF combined with pulmonary hypertension.Pearson,Spearman and multivariate linear regression were used to analyze the correlation between pulmonary systolic pressure(PASP)and echocardiographic indicators was analyzed.Results:64 patients with HFpEF combined with pulmonary hypertension,accounting for 52.0% of patients with HFpEF.(1)Binary logistic regression analysis found that gender,AF,HTN,increased of left atrial volume and internal diameter were risk factors for the occurrence of pulmonary hypertension in HFpEF(OR=1.035~17.930,P=0.001~0.036),while HDL and Folic acid were protective factors for the occurrence of pulmonary hypertension in HFpEF(OR=0.540~0.822,P=0.004~0.017).(2)Compared with the HFpEF without pulmonary hypertension group,folic acid,EPO and left ventricular end-diastolic index(LVEDVi,LVEDV)in the combined with pulmonary hypertension group were all lower(P<0.05).(3)In the HFpEF combined with pulmonary hypertension group,age,BMI,waist-hip ratio,DM,peripheral edema,laboratory indexes(HDL,BUN,GLU,HbA1c%),indicators of pulmonary artery,pulmonary vein and inferior vena cava(PA,S,IVCexp),indicators of left atrium,right heart(LAD,LADi,LAV,LAVi,RVOT2,RVF-Ws,RVF-Wd,RA-D1,RA-D2,RAA)and indicators of left ventricular diastolic function(E,A,E/E'S,E/E',E/E'L),LVEF were higher than without pulmonary hypertension group and normal control group(P< 0.05),while the MCHC was lower than the other two groups(P<0.05).Among the above indicators,except for HDL and HBG,the HFpEF without pulmonary hypertension group was higher than the normal control group(P<0.05).(4)Linear correlation study found that PASP was negatively correlated with LVEDVi,while positively correlated with IVCinsp,LAD,LAV,RA-D2,and RAA.Multiple linear regression found that PASP was independently and negatively correlated with LVEDVi(r=-0.164,P= 0.015),while independently and positively correlated with IVCinsp(r=0.796,P=0.044).Conclusion:(1)Female,atrial fibrillation,hypertension,and low HDL are risk factors for the occurrence of pulmonary hypertension in HFpEF.(2)The age,BMI,blood glucose level,left atrial and right heart diameter and volume of patients with HFpEF complicated with pulmonary hypertension were higher than those without pulmonary hypertension and healthy people.(3)The level of PASP was related to LAD,LVEDVi,IVCinsp.