| Research Background and ObjectiveHeart failure is a clinical syndrome that manifests as various cardiac dysfunctions.In fact,as the condition progresses,heart disease will develop to heart failure eventually.The pathophysiological mechanisms of heart failure include structural,neurohumoral,cellular and molecular mechanisms activated to maintain physiological function.Due to the variety of mechanisms and different treatment options and prognosis,the 2021 General Definition and Classification of Heart Failure diagnoses left ventricular ejection fraction(LVEF)≤ 40% as heart failure with reduced ejection fraction(HFrEF).Heart failure with mildly reduced ejection fraction(HFmrEF)is based on 40% < LVEF < 50%,and heart failure with preserved ejection fraction(HFpEF)is based on LVEF > 50%.Also,heart failure with improved ejection fraction(HFimpEF,LVEF ≤ 40% at baseline,LVEF > 40% at second measurement and ≥ 10% increase from baseline)was proposed based on the degree of improvement in LV ejection fraction between initial and remeasurement.Compared with developed countries,there are relatively few studies on heart failure with different ejection fraction types in China,and there is a lack of large clinical studies related to HFimpEF.The purpose of this study is to discuss the clinical characteristics and prognosis of heart failure with different ejection fraction types,and to analyze the etiology,treatment,outcome,and influencing factors of heart failure with improved ejection fraction.This is a retrospective single-center study based on the electronic medical record system to collect and analyze the clinical characteristics,prognosis and influencing factors of heart failure with different ejection fraction types,and to provide more basis for clinical treatment strategies for patients with different ejection fraction types of heart failure in China.MethodsPatients with heart failure who were admitted to the Department of Cardiology of the Second Hospital of Guangzhou Medical University from January 2018 to April2022 and met the diagnostic criteria for heart failure in the 2021 General Definition and Classification of Heart Failure were included in this study and were divided into the HFrEF group,HFmrEF group,and HFpEF group.Referring to the diagnostic criteria,the cases in the HFrEF group included were grouped according to the degree of improvement in ejection fraction,and were divided into the group with no significant improvement in LVEF(baseline LVEF ≤ 40%,with < 10% or no improvement in left ventricular ejection fraction at the second measurement compared with the initial measurement),and HFimpEF(baseline LVEF ≤ 40%,with LVEF >40% at the second measurement and ≥ 10% increase from baseline).General patient data,etiology and history data,laboratory tests and echocardiography,comorbidities,discharge with medication,coronary angiography,radiofrequency ablation and other imaging data and related treatments were collected from the electronic case system,medical prescription system,testing system and imaging system of the Second Affiliated Hospital of Guangzhou Medical University.Follow-up was performed through the imaging system and outpatient system,and the interval between re-measurement follow-up was > 3 months.Results1.Baseline DemographicsAccording to the nadir criteria,626 cases were included in this study,of which 33.0%(207 cases)were HFrEF patients,23.5%(147 cases)were HFmrEF patients,and 43.5%(272 cases)were HFpEF patients.The HFrEF group had the youngest patients,the lowest systolic blood pressure,and the highest number of people in Classes III-IV of New York Heart Association(NYHA)cardiac function(P < 0.05).The median follow-up was 7.6 months,and during the follow-up period,47.7%(51cases)of patients with HFrEF whose LVEF met the HFimpEF-related criteria on repeat echocardiography.Systolic blood pressure was higher in patients with HFimpEF compared with the group with no significant improvement in LVEF(P<0.05).2.Etiological Analysis of Heart FailureIn this study,ischemic heart disease was the most common cause(32.6%).The highest percentage of patients in the HFrEF group had dilated cardiomyopathy(40.1%),the most frequent cause was ischemic heart disease in the HFmrEF group(54.4%),hypertension(30.9%)was the more frequent cause in the HFpEF group,and heart valve disease(25.4%)and atrial fibrillation(9.6%)were also higher than in the other two groups(P < 0.001).3.Laboratory DataCompared with the HFrEF,HFmrEF and HFpEF groups,HFpEF had lower brain natriuretic peptide(BNP),hemoglobin and alanine aminotransferase(ALT),while HFrEF had higher BNP,hemoglobin,low-density lipoprotein cholesterol(LDL-C),AST,and LDL-C.HFrEF has higher BNP,hemoglobin,low-density lipoprotein cholesterol(LDL-C),aspartic amino acid aminotransferase(AST),uric acid,estimated glomerular filtration rate(e GFR),and a higher level of hemoglobin,low-density lipoprotein cholesterol(LDL-C),with a significant difference between the three(P < 0.001).4.Echocardiographic DataCompared with the HFrEF,HFmrEF and HFpEF groups,the left ventricular end systolic diameter(LVDSD),left ventricular end systolic volume(LVESV),left ventricular end diastolic volume(LVEDV),and left ventricular end diastolic diameter(LVEDD)were higher in the HFrEF group than in the other two groups.The left ventricular end diastolic volume(LVEDV)and left ventricular end diastolic diameter(LVEDD)were larger in the HFpEF group than in the other two groups,and the LVDSD,LVESV,LVEDV,and LVEDD were larger in the HFpEF group than in the other two groups,LVESV,LVEDV and LVEDD were less in the HFpEF group than in the other two groups,and the differences were statistically significant(P < 0.001).5.Treatment(1)In terms of discharge with medication,the highest percentage of diuretics use(86.1%)was seen with the new quadruple drug profile: β-blockers(89.6%),aldosterone receptor antagonists(67.0%),ACEI/ARB(49.5%),ARNI(27.9%),SGLT2 inhibitors(16.3%).the HFrEF group,HFmrEF group and HFpEF group Compared with the HFrEF group,the rate of ARNI and aldosterone receptor antagonist use was higher in the HFrEF group compared with the other two groups(P< 0.001).(2)For non-pharmacological treatment during hospitalization,percutaneous coronary interventions treatment was less in the HFpEF group than in the other two groups.Compared with the group with no significant improvement in LVEF,patients with HFimpEF had more use of β-blockers and aldosterone receptor antagonists,and all differences were statistically significant(P < 0.05).6.ComplicationsRenal insufficiency(69.3%)and anemia(67.2%)were the most common comorbidities.The proportion of HFrEF combined with hypertension,anemia,and atrial fibrillation was the lowest among the three study populations,and heart failure with anemia was the most common in the HFpEF group(P < 0.001).Conclusion1.Each of the three types of heart failure has different clinical features.The etiology of HFrEF group is more dilated cardiomyopathy,the etiology of HFmrEF group is more ischemic heart disease,and the etiology of HFpEF group is more hypertensive.Patients with HFrEF have lower systolic blood pressure,worse NYHA cardiac function level,higher BNP,wider LVEDD,and more use of ARNI,aldosterone receptor antagonists.2.Treatment with β-blockers and aldosterone receptor antagonists at discharge,patients with relatively smaller left ventricular end-systolic internal diameters and left atrial internal diameters with HFrEF were more likely to improve LVEF. |
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