| [Background]Heart failure causes Cardiac circulatory disorder syndrome.Heart failure is a serious manifestation or late stage of various heart diseases,and the mortality and rehospitalization rate remain high.Data from developed countries show that the prevalence of population-centered failure is 1.5%to 2.0%,and the prevalence of people aged 70 and above is≥10%.An epidemiological survey in 2003 showed that the prevalence of chronic heart failure among people aged 35 to 74 in my country was 0.9%.About 50%of patients with heart failure are HFpEF,which is more common in elderly,female,hypertension and atrial fibrillation patients.In the past 30 years,although significant results have been achieved in the pathogenesis,pathophysiology,and prevention of heart failure,with high mortality and rehospitalization rates.Foreign studies have shown that the 30-day,1-year,and 5-year mortality rates of hospitalized patients with heart failure are 10.4%,22%,and 42.3%,respectively.The 1-year rehospitalization rates of inpatients with heart failure and stable heart failure are 44%and 32%,respectively.The leading cause of death in patients with heart failure is cardiovascular death,including sudden death and pump failure.A survey of 10714 hospitalized patients with heart failure in China showed that the mortality rates of patients with heart failure during hospitalization in 1980,1990,and 2000 were 15.4%,12.3%,and 6.2%,respectively.An epidemiological survey in 2003 showed that the prevalence of heart failure among adults aged 35 to 74 in my country was 0.9%.The aging of the population in my country is increasing,and the incidence of chronic diseases such as coronary heart disease,hypertension,diabetes,and obesity is on the rise.The improvement of medical standards has prolonged the survival time of patients with heart diseases,leading to a continuous increase in the prevalence of heart failure in my country.A survey of 10714 hospitalized patients with heart failure in China showed that the mortality rates during hospitalization of heart failure patients in 1980,1990,and 2000 were 15.4%,12.3%,and 6.2%,respectively,and the main causes of death were left heart failure(59%),Arrhythmia(13%)and sudden cardiac death(13%).The China-HF study showed that the case fatality rate of hospitalized patients with heart failure was 4.1%.[Objective]There are great differences in the structure and function of the heart in patients with heart failure,ranging from normal left ventricular size and left ventricular ejection fraction to severe ventricular dilatation and/or significantly lower LVEF.Hemodynamic disorders are manifested as decreased cardiac output and congestion of pulmonary or systemic circulation,and their severity is often consistent with the symptoms and signs of heart failure.The lower the LVEF of patients with chronic HFrEF and HFmrEF,the worse the prognosis of patients.Therefore,clinical attention to the patient’s LVEF is of great significance in judging the prognosis of patients.The guidelines for rational use of drugs for heart failure in my country point out that 12 clinical parameters are related to the poor prognosis of patients with heart failure.Among them,LVEF occupies the first place.Foreign studies indicate that the risk factors for death in patients with heart failure within 30 days include:age,smoking,increased red blood cell distribution,increased CTn1,increased N-terminal brain natriuretic peptide,decreased left ventricular ejection fraction,and renal function Insufficiency,ventricular arrhythmia,type 2 diabetes,hypertension,coronary heart disease(CHD)and bronchitis.[Methods]1.Collect patients:clinical data of patients with chronic HFrEF and HFmrEF who were admitted to the outpatient department of Cardiology Department of Qilu Hospital of Shandong University from August 2010 to February 2021,and were enrolled and excluded according to corresponding standards.Inclusion criteria:Patients who have been diagnosed with heart failure in the past,and are between 18 and 80 years old,regardless of gender;patients who have been at least one month from the initial outpatient visit to the most recent follow-up or follow the doctor’s regular outpatient follow-up visit for at least one month;Patients with echocardiographic results and corresponding observation indicators within 1 month before and after the initial outpatient visit or regular follow-up visit;patients with LVEF<0.5 within 1 month before and after the initial out-patient visit or regular follow-up date;the outpatient follow-up process has been accepted in accordance with China Heart failure treatment guidelines(2014)recommend patients who have been taking the drug for 4 weeks.Exclusion criteria:patients who have previously received major surgery or organ transplantation;severe primary diseases such as liver and kidney,hematopoietic system,nervous system,endocrine system,etc.,new or unregularly treated during follow-up,tumor patients,mental patients,and major mental trauma Patients;patients who were pregnant or breast-feeding during the follow-up period;patients who did not accept medications that meet the recommendations of the Chinese Heart Failure Treatment Guidelines(2014)for 4 weeks,such as changing the drug dose or stopping the drug without authorization.2.Follow-up observation and data collection:collect the known outpatient medical records of patients.The results of laboratory tests and examinations establish a patient information database.While giving patients the standard treatment plan for heart failure,the patients were subject to long-term and regular telephone calls combined with outpatient follow-up to collect the above clinical data.3.Establish a database and statistical analysis:According to whether the ejection fraction returns to normal after treatment,the patients are divided into two groups,and the factors that may affect the ejection fraction recovery in the two groups are compared and analyzed,such as gender,age,and comorbidities,Lifestyle,past history,blood pressure and heart rate,NT-proBNP,liver and kidney function,blood glucose and blood lipids,electrolytes,PT-INR,cardiac ultrasound indicators and medication regimens,etc.Use statistical methods to analyze the factors that may affect the recovery of LVEF.[Results]A total of 577 outpatients were followed up.After screening according to the exclusion and enrollment criteria,the number of patients who met the enrollment criteria was 236.Assume △LVEF=(latest LVEF-newly diagnosed LVEF)/firstly diagnosed LVEF×100%.△LVEF>0 was defined as the ejection fraction recovery group,and ΔLVEF≤0 was defined as the ejection fraction unrecovered group.After outpatient follow-up,there were 169 cases(76.27%)in the recovery group and 67 cases(23.73%)in the non-recovery group.After outpatient diagnosis and treatment,the proportion of recovered patients is much higher than that of unrecovered patients,suggesting the importance and necessity of outpatient diagnosis and treatment.1.Demographic epidemiological characteristics and baseline characteristics:Of the 236 patients enrolled,174(73.7%)were male and 62(26.3%)were female.There is no gap in LVEF recovery between males and females,and males and females will have LVEF in the future.The possibility of recovery is the same,and gender has no effect on the recovery of LVEF.Age<30 years was enrolled in 6 patients(2.5%),30 years≤and<50 years in 29 patients(12.3%),50 years≤and<70 years in 83 patients(35.2%),and≥70 years in 30 patients(12.7%).sBP was 126.5(113～143.25)mmHg in the recovered group and 122(109.75～139.25)in the unrecovered group mmHg(P value=0.250>0.05);DBP was 76(69～88)mmHg in the recovered group and 77(65.75～90.25)mmHg in the unrecovered group(P value=0.800>0.05);HR was 75(66～87)bpm in the recovered group and 74(65～89)bpm in the unrecovered group(P value=0.931>0.05).Among the 236 patients enrolled,the number of patients with definite NYHA classification at the time of initial diagnosis was 150.15 patients(6.3%)had NYHA classification 1,57 patients(24.0%)had NYHA classification Ⅱ,50 patients(21.0%)had NYHA classification III,and 28 patients(11.7%)had NYHA classification Ⅳ.The patients’ NYHA classification at the initial diagnosis was divided into)≥Ⅲ and<Ⅲ.In the recovery group of patients with definite NYHA classification,there were 55 patients(52.4%)with NYHA classification≥Ⅲ and 50 patients(47.6%)with NYHA classification<Ⅲ.In the unrecovered group,there were 23 patients(51.1%)with NYHA classification≥Ⅲ and 22 patients(48.9%)with NYHA classification<Ⅲ.To further verify whether the NYHA grading status of patients at the time of initial consultation affected the recovery of LVEF,after chi-square test,the P value was 0.887>0.05,which means that there was no gap in LVEF recovery between the NYHA grading status at the time of initial consultation,and the NYHA grading at the time of initial consultation did not affect the recovery of LVEF.2.Heart failure etiology and concomitant diseases:There were 231 patients with a clear etiology in the enrolled patients,106 patients(45.9%)with ischemic myocardium and 125 patients(54.1%)with non-ischemic cardiomyopathy.The percentage of recovery among patients with ischemic cardiomyopathy was 60.4%,and the percentage of recovery among patients with non-ischemic cardiomyopathy was 80.8%.There was a significant difference in the recovery of LVEF between ischemic cardiomyopathy and nonischemic cardiomyopathy by chi-square test(P value=0.001<0.05),with 60.4%of patients with ischemic cardiomyopathy recovering LVEF and 80.8%of patients with nonischemic cardiomyopathy recovering LVEF,and patients with nonischemic cardiomyopathy were more likely to recover LVEF later than patients with ischemic cardiomyopathy in patients with ischemic cardiomyopathy,and this result was statistically significant.Among the enrolled patients,there were 198 patients with clear hypertension,103 patients(52.0%)with non-hypertension,and 95 patients(48.0%)with hypertension.The proportion of recovered people in hypertensive patients was 76.8%,and that in non-hypertensive patients was 68.9%(P value=0.212>0.05).Among the enrolled patients,there were 200 patients with a clear condition of diabetes,including non-diabetic patients(79.0%)and diabetic patients(21.0%).The proportion of recovered people in diabetic patients was 64.6%,and the proportion of recovered people in non-diabetic patients was 71.5%(P value=0.359>0.05).Among the enrolled patients,there were 200 patients with a clear condition of atrial fibrillation,163 patients(81.5%)of non-AF patients,and 37 patients(18.5%)of atrial fibrillation patients.The proportion of recovered people in patients with atrial fibrillation was 73.0%,and the proportion of recovered people in non-AF patients was 72.4%(P value=0.943>0.05).Among the enrolled patients,there were 194 patients with a clear history of PCI or CABG,145 patients(74.7%)without PCI and CABG treatment,and 49 patients(25.3%)after PCI or CABG.The proportion of recovered patients in treated patients was 69.4%,and the proportion of recovered patients in untreated patients was 72.4%(P value=0.685>0.05)3.Past history of tobacco and alcohol:Among the 236 patients enrolled,129 cases can be identified as having a history of smoking,59 cases(45.74%)have a history of smoking,and 70 cases have no history of smoking.(54.26%).Among the enrolled patients,the proportion of non-smokers was higher than that of smoking patients(P value=0.910>0.05).Among the 236 patients enrolled in the group,the number of patients with a history of drinking was 132,the number of patients with a history of drinking was 48(36.36%),and the number of patients without a history of drinking was 84(63.64%)(P value)=0.543>0.05).Because P values were all>0.05,there was no significant statistical difference in the proportion of LVEF recovery in the two groups with a history of smoking and drinking.4.Laboratory indicators at the first diagnosis:NT-proBNP was 647.9(209.85～2205.75)pg/ml in the recovery group,and 944(412.1～2893)pg/mL in the unrecovered group,P value=0.056>0.05;ALT was in 22(15～36)U/L in the recovery group,22.35(14～30)U/L in the unrecovered group,P value=0.370>0.05;AST in the recovery group was 23(17～29)U/L,The unrecovered group was 22(17.75～27.85)U/L,P value=0.597>0.05;Cr was 79(69.825～92.25)μmol/L in the recovery groμp,and 76.5(67～90)μmol/L in the unrecovered group L,P value=0.513>0.05;blood glucose in the recovery group is 5.49(4.655～6.16)mmol/L,in the unrecovered group it is 5.29(4.74-6.365)mmol/L,P value=0.741>0.05;LDL-C It was 2.185(1.715～2.665)mmol/L in the recovery group,2.15(1.75～2.7525)mmol/L in the non-recovery group,P value=0.699>0.05;HDL-C was 1.04(0.87～1.22)in the recovery group)mmol/L,1.06(0.965～1.2775)mmol/l in the unrecovered group,P value=0.554>0.05;cholesterol in the recovery group is 3.75(3.18～4.43)mmol/L,in the unrecovered group it is 3.735(3.2025～4.4725)mmol/L,P value=0.971>0.05,;triglycerides are 1.23(0.93～1.9)mmol/L in the recovery group,and 1.45(0.89～1.7)mmol/L in the unrecovered group,P Value=0.751>0.05;the blood sodium recovery group is 141(139.7～143)mmol/L,the unrecovered group is 141(137.75～143)mmol/L,P value=0.292>0.05;PT-INR in the recovery group is 1.12(1.06～1.87),in the unrecovered group 1.17(1.04～1.8725),P value=0.905>0.05;the average blood potassium of the recovery group was 4.3076±0.40971 mmoL/L,and the blood potassium of the unrecovered group was 4.3368±0.46944 mmol/L,P Value=0.670>0.05;the above results are all P values>0.05.There is no significant difference in various laboratory indicators between the two groups with LVEF recovery and non-recovery.5.Echocardiac index at the first visit:Calculated by independent sample t-test,the average LV of the recovery group was 59.855±8.4720 mm VS the average of the unrecovered group was 61.802±9.1625 mm(P value=0.125>0.05);the average ascending aorta of the recovery group 31.287±4.6321 mm VS mean ascending aorta 32.164±4.5897 mm in the unrecovered group(P=0.242>0.05);LA is 42(39～49)mm in the recovery group VS 43(40～49)in the unrecovered group mm(P value=0.437>0.05);RA in the recovery group is 1974(1599～2439)mm^2 VS in the unrecovered group is 1932(1558～2188.5)mm^2(P value=0.531>0.05);RV is recovering Group is 24(21～27)mm VS is 24(21～27)mm in the unrecovered group(P value=0.871>0.05);IVS is 10(9～11)mm in the recovery group and 10(9～11)mm in the unrecovered group 9～12)mm(P value=0.983>0.05);LVPW is 10(8～10)mm in the recovery group VS 9.4(9～10)mm in the unrecovered group(P value=0.967>0.05);main pulmonary artery In the recovery group,it was 24(22～27)mm VS,and in the unrecovered group,it was 25(23～28.25)mm(P value=0.219>0.05);E/e’ was 12.09(9.4～22.15)VS in the recovery group.In the recovery group,15(11.65～20.2)(P value=0.299>0.05),the above-mentioned echocardiographic indexes were all due to P value>0.05,the difference was not statistically significant.The maximum systolic right atrial probing and tricuspid regurgitation pressure difference at the first diagnosis was 27(22～33)mmHg in the recovery group and 33(25～46)mmHg in the unrecovered group,P value=0.021<0.05.The pulmonary artery systolic pressure was 32(27～42)mmHg in the recovery group and 38(30.5～54.5)mmHg in the non-recovery group,P value=0.018<0.05.The average initial diagnosis LVEF of the recovery group was 35.008±9.1238%,the average initial diagnosis LVEF of the unrecovered group was 39.104±9.9790%,P=0.003<0.05.The result is statistically significant.6.Use of heart failure drugs:233 cases(98.3%)of beta-blockers were used in the enrolled patients,204 cases(86.4%)of Betaloc sustained-release tablets,and 24 cases of Kangxin(10.1%),Jinluo 4 cases(1.6%),Bosu 1 case(0.4%).Among β-blocker users,141 patients(60.8%)met the standard dose,and 92 patients(39.5%)did not meet the standard.Among the unrecovered patients,64(95.6%)were BB drug users and 39(57.8%)met the target;169(100%)were BB drug users in the recovery group and 104(61.5%)were met the target.Therefore,the use rate and compliance rate of BB drugs in the unrecovered group were lower than those in the recovery group.The chi-square test is performed on whether β-blockers meet the standard and whether LVEF is restored,and the P value=0.605>0.05.Therefore,regardless of whether the B-blockers meet the standard,the possibility of LVEF recovery is not significantly different,and there is no significant statistics.significance.The number of ACEI users in the enrolled patients reached 89 cases(37.7%),54 cases(22.6%)of Yasta,32 cases(13.6%)of Lotensin,2 cases(0.8%)of Issu,and Da Shuang.1 case(0.4%).Among ACEI users,86 cases(96.6%)had reached the standard,and 3 cases(3.4%)had not reached the standard.Among the unrecovered patients,31 were ACEI drug users(46.3%),and 29(43.3%)met the target;58(34.3%)were ACEI drug users in the recovery group,and 57(33.7%)met the target.Therefore,the use rate and compliance rate of ACEI drugs in the unrecovered group were higher than those in the recovery group.The chi-square test was performed on whether ACEI was up to standard and whether LVEF was restored,and the P value was 0.575>0.05 Therefore,no matter whether the dose of ACEI was up to standard,there was no significant difference in the possibility of LVEF recovery,and there was no significant statistical significance.The number of ARB used in the enrolled patients reached 73(30.9%),27 cases(11.4%)in Cozaar,23 cases(9.7%)in Divin,18 cases(7.6%)in Bilos,and 3 cases in Ambow.Cases(1.2%),1 case of Ambono(0.4%),and 1 case(0.4%)of Fudaiwen.Among ARB users,35 patients(47.9%)had met the standard dose,and 38 patients(52.1%)had not met the standard.Among the unrecovered patients,18 were ARB drug users(26.9%)and 11(16.4%)met the target;55 ARB drug users(32.5%)were in the recovery group,and 24(14.2%)met the target.P value=0.309>0.05,so whether the ARB dose reaches the standard or not,there is no significant difference in the possibility of LVEF recovery,and there is no significant statistical significance.ARNI was used in 71 patients(30.1%)in the enrolled patients,42 patients(17.7%)with a total daily dose of 400 mg,and 6 patients(2.5%)with a total daily dose of 300 mg.4 cases(1.6)received a total dose of 250 mg,6 cases(2.5%)received a total daily dose of 200 mg,1 case received a total daily dose of 175 mg(0.4%).The compliance rate among ARNI patients was 59.2%.Among the unrecovered patients,17 were ARNI drug users(25.4%),and 10(14.9%)met the target;54 ARNI drug users(32.0%)were in the recovery group,and 32(18.9%)met the target.P value=0.975>0.05,so whether the ARNI dose reaches the standard or not,there is no significant difference in the possibility of LVEF recovery,and there is no significant statistical significance.The use of spironolactone in the enrolled patients reached 120(50.8%).Among the unrecovered patients,41 cases(61.2%)were spironolactone users;79 cases(46.7%)were spironolactone users in the recovery group.Therefore,the use rate of spironolactone in the non-recovery group was higher than that in the recovery group.The use of spironolactone can cause a significant gap in the recovery of LVEF.In the spironolactone group,the recovery rate of patients was 65.8%;in the non-spironolactone treatment group,the recovery rate of patients was 77.6%,(P value=0.045<0.05).Patients who do not take spironolactone may have higher LVEF recovery than those who take spironolactone,and this result is statistically significant.The number of diuretics(including furosemide,imago,and nazine)used in the enrolled patients reached 61(25.8%).Among the unrecovered patients,25 were diuretic users(37.3%);in the recovery group,36 were diuretic users(21.3%),and the diuretic use rate in the unrecovered group was higher than that in the recovery group.The chi-square test was performed on whether to use diuretics and whether LVEF was restored.In the diuretic group,the proportion of patients who recovered was 59.0%;in the non-diuretic treatment group,the proportion of patients who recovered was 76.0%,(P=0.011<0.05).Patients who do not take diuretics may have higher LVEF recovery than those who take diuretics,and this result is statistically significant.Among the enrolled patients,ivabradine used up to 19 cases(8.1%).Among the unrecovered patients,6(9.0%)were users of ivabradine;13(7.7%)were users of ivabradine in the recovery group.Among the enrolled patients,41 patients(17.3%)used anticoagulants.Among the unrecovered patients,13 were anticoagulant users(19.4%);in the recovery group,28 were anticoagulant users(16.6%).Whether the above BB drugs,ACEIs,ARBs,ARNIs meet the standards,whether ivabradine and anticoagulants are used,the difference between the groups through the chi-square test and the recovery of LVEF,the calculated P value is all>0.05,so it is not available Statistical significance:The use of spironolactone and diuretics is the difference between the groups through the Chi-square test and the recovery of LVEF.The calculated P value is<0.05.Patients who do not take spironolactone or diuretics are more likely to recover from LVEF than taking the drug.The results are statistically significant.[Conclusion]In this article,follow-up statistics found that in patients with chronic HFrEF and HFmrEF:1.Patients with non-ischemic cardiomyopathy are more likely to recover from late LVEF than patients with ischemic cardiomyopathy.2.Patients with a lower level of systolic right atrial probing and maximum tricuspid regurgitation pressure at the first diagnosis are more likely to recover from LVEF in the later stage than those with higher values.27(22～33)VS 33(25～46)mmHg.3.Patients with low pulmonary artery systolic blood pressure at the time of initial diagnosis are more likely to recover from LVEF in the later period than patients with a higher value.32(27～42)VS 38(30.5～54.5)mmHg4.Patients with low LVEF at the first diagnosis(35.008±9.123 8%)are more likely to recover from LVEF later than those with high LVEF(39.104±9.9790%).5.Patients who do not take spironolactone are more likely to recover from LVEF than those who take the drug.6.Patients who do not take diuretics are more likely to recover from LVEF than those who take the drug.7.Although the above 6 factors can significantly cause the difference in ejection fraction recovery,they are not independent factors8.The ejection fraction of patients before and after outpatient treatment was significantly improved,with LVEF 36(30～42)%at the first visit vs.44.5(35.25～55)%after treatment(P=0.000<0.05).Confirmed the improvement effect of regular outpatient and follow-up management on LVEF. |
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