| Objective:To research the relationship between heart failure with preserved ejection fraction and myocardial energy metabolism for one year follow-up,and to explore the valuable diagnostic and monitoring indexes of heart failure with preserved ejection fraction Method:From June 2016 to may 2018,selected patients from Affiliated Zhongshan Hospital of Dalian University from the technology of the people’s Republic of China on the prospective cohort study of heart failure in the national registration of major chronic diseases(china pace 5p-HF)project,who met the diagnostic criteria of heart failure with preserved ejection fraction(HFp EF)in the guidelines for the diagnosis and treatment of ESC acute and chronic heart failure in 2016.After the condition was stable,they signed the informed consent and completed the echocardiography.According to the value of E/e’,the subjects were divided into two groups: A(8≤E/e’≤15)and B(E/e’>15),baseline data including general information: age,gender,body mass index,body surface area,blood pressure,heart rate,six minute walking test,basic disease;biochemical data: liver and kidney function,blood lipid,blood sugar,glycosylated hemoglobin,electrolyte,N-terminal brain natriuretic peptide precursor,valine,leucine and free carnitine;echocardiography data of heart: cardiac output,cardiac index,stroke volume,tricuspid regurgitation velocity,and calculate fractional shortening,left ventricular ejection fraction and myocardial energy metabolism.Then the patients were followed up for one year,and color Doppler echocardiography was performed again to evaluate their cardiac function.At the same time,20 physical examinees(10 males and 10 females)who had no previous medical history,had normal physical examination and biochemical examination,importantly LVEF>50% and E/e’<8 were selected as the control group.Spss25.0 statistical software was used for statistical processing.The measurement data were tested by t-test and the count data by rank sum test.Bivariate correlation analysis,ROC curve and survival curve were used to process the data.Results:The baseline of general data include age,gender,basic diseases,body mass index,body surface area,mean arterial pressure,heart rate,six minute walking test,biochemical data include triglyceride,cholesterol,high density lipoprotein,low density lipoprotein,Glucose,Glycosylated hemoglobin,N-terminal brain natriuretic peptide precursor,albumin,globulin,alanine transaminase,aspartate transaminase,Serum creatinine,blood ureanitrogen,uric acid,potassium,sodium,chlorine,valine,leucine and free carnitine;echocardiographic data include cardiac output,cardiac index,stroke output,tricuspid regurgitation velocity,fractional shortening,left ventricular ejection fraction for group A and group B have no significant difference(p<0.05).Evaluation of myocardial energy metabolism parameters based on echocardiography : The level of myocardial energy metabolism were(115.87 ± 31.53Kcal/min vs.123.01 ± 65.47Kcal/min vs.144.83 ± 70.80Kcal/min)in control group,group A and group B.There was no statistical significance between group A and control group(p=0.746),but Group B has statistical significance with control group(p=0.017)and group A(p=0.040).Myocardial energy metabolism has positively correlation with body mass index(r= 0.213,p=0.017),it also has negatively correlation with six minute walking test(r=-0.379,p=0.000)and alanine aminotransferase(r=-0.187,p=0.037).After adjusting for age,gender,height and weight,Myocardial energy metabolism has positively correlation with N-terminal brain natriuretic peptide precursor(r=0.202,p=0.027)and Serum creatinine(r=0.215,p=0.018),it has negatively correlation with six minute walking test(r=-0.305,p=0.001).According to ROC curve analysis,the area of MEE under the curve was0.61,the diagnostic cut-off point was 101.68kcal/min,sensitivity is 75%,specificity is45%.LVEF at 1-year follow-up compared with baseline: group A were(64.77±4.74% vs.64.97±4.57%),it has no statistically significant(p=0.234);group B were(62.04±6.39% vs.64.88±4.59%),the difference has statistically significant(p=0.001).LVEF in group B was significantly lower than that in group A in one year follow-up(62.04±6.39% vs.64.77±4.74%),the difference has statistically significant(p=0.033).According to the survival curve,the myocardial energy consumption of101.68kcal/min can be used as the threshold(inflection point)to predict cardiovascular events,and when myocardial energy consumption was more than101.68kcal/min,cardiovascular events increased significantly.Conclusion : In HFp EF,Myocardial energy metabolism(MEE)based on echocardiography showed an increasing trend and significant difference between groups with 8≤E/e’<15 and E /e’>15,in addition,myocardial energy expenditure was consistent with NT-pro BNP and 6MWT in evaluating the degree of deterioration of heart failure.The myocardial energy consumption of 101.68kcal/min can be used as athreshold to predict cardiovascular events and have relation with prognosis.The measurement of myocardial energy metabolism by echocardiography is a valuable index to reflect the diastolic dysfunction and to judge the prognosis. |
PDF Full Text Request