| 【Objective】To study the clinical characteristics and long-term prognosis of patients with heart failure of preserved ejection fraction and type 2 diabetes mellitus(T2DM).【Methods】Four-hundred and eighteen patients with heart failure who were hospitalized in the East Hospital of Shanghai Sixth People’s Hospital from December 2015 to December 2018 were enrolled.According to the values of left ventricular ejection fraction(LVEF),patients were divided into three groups: heart failure with preserved left ventricular ejection fraction(HFp EF)group(LVEF≥50%),middle range ejection fraction heart failure(HFmr EF)group(LVEF 40-49%)and heart failure with reduced ejection fraction(HFr EF)group(LVEF<40%).The general clinical conditions,main echocardiography results and serological indexes were compared among the three groups.The patients were followed up for mean 3 years,and the prognosis among three groups were compared.262 patients with HFp EF were divided into two groups according to their status of having T2DM: combined group(HFp EF with T2 DM group)and non-combination group(HFp EF without T2 DM group),and clinical features and prognosis of the two groups were compared.【Results】1.Compared to patients with HFmr EF and HFr EF,the proportion of females [52.7% vs 39.1% vs 31.9%,P=0.003]and atrial fibrillation[61% vs 36% vs 39%,P<0.001] in HFp EF group was higher,the left ventricular end diastolic diameter [(49.05±6.17)mm vs(57.35±5.91)mm vs(60.72±5.81)mm,P<0.001] and left ventricular end systolic diameter [(33.70±4.86)mm vs(44.50±5.29)mm vs(50.58±6.16)mm,P<0.001] were smaller,while the LVEF values [(58.40±4.40)% vs(43.97±2.81)% vs(33.96±3.86)%,P<0.001] and left ventricular fractional shortening [(30.70±3.15)% vs(22.35±3.51)% vs(16.79±2.13)%,P<0.001] were larger;the heart function grade of HFr EF group was worse,and the levels of N-terminal pro-B-type natriuretic peptide and Troponin I were higher in HFr EF group.Compared to patients with HFr EF,the proportion of hypertension was higher[75% vs 76% vs 52%,P=0.001];the K-M survival map of the three groups showed that the prognosis was similar to that of HFmrEF group,and better than that of HFrEF group(χ2=8.546,P=0.014).Cox multivariate analysis showed that male gender [HR:1.776,95%CI: 1.186-2.658,P=0.005],The proportion of age ≥ 80 years old was high [HR:2.260,95%CI: 1.149-3.420,P<0.001],NYHA grade Ⅳ [HR:1.822,95%CI:1.124-2.953,P=0.009] and Lg NT-pro BNP≥3.7 ng/L [HR:2.390,95%CI:1.403-4.072,P=0.002] were independent risk factors of all cause death in patients with heart failure.2.Compared with the non-combined group,HFp EF combined with T2 DM had younger age,higher absolute values of neutrophil,fasting glucose,glycosylated hemoglobin,triglyceride,and higher proportion of hypertension,coronary heart disease and angina pectoris(all P<0.05).K-M analysis showed that there was no significant difference in all-cause mortality between the two groups.Cox multivariate analysis showed that NYHA grade IV [HR:2.618,95%CI:1.41-4.864,P=0.006] and high proportion of absolute neutrophil count ≥5×109/L [HR:1.928,95%CI:1.163-3.198,P=0.011] were independent risk factors of all cause death in HFp EF patients.【Conclusions】The clinical characteristics and long-term prognosis among patients of heart failure with different values of LVEF are different.The prognosis of HFp EF group was similar to that of HFmr EF group,better than that of HFr EF group.Gender,age,NYHA classification and Lg NT-pro BNP were independent risk factors of death in patients with heart failure.NYHA grade and absolute neutrophil count were independent factors of all cause death in HFp EF patients.HFp EF combined with T2 DM group had a higher inflammatory index and a higher proportion of hypertension,coronary heart disease and angina pectoris than those without T2 DM group,and there was no significant difference in all-cause mortality between the two groups. |
