The Analysis Of Heart Failure With Reduced,Mid-Range And Preserved Ejection Fraction In Clinical Characteristics

Objective:Heart failure is the late manifestation and outcome of various heart diseases.From the perspective of pathophysiology,abnormal changes in the structure and function of the heart caused by various causes,which in turn affect the ventricular contraction and or diastolic dysfunction,eventually caused a complex clinical syndrome with difficulty in breathing and fatigue.And liquid retention and so on as the main performance.According to the 2016 ESC guidelines for acute and chronic heart failure,heart failure was defined as three types according to the left ventricular ejection fraction(LVEF): heart failure with reduced(HFr EF),preserved(HFp EF)and mid-range ejection fraction(HFmr EF).The new classification of heart failure provide us opportunity to analysis,discuss and compare the clinical features and treatment.Methods:This study enrolled 258 patients with heart failure treated in the Department of Cardiology,Tianjin Medical University Second hospital from October 2017 to September 2018.They were divided into three groups according to the current guidelines of heart failure,in which 86 patients HFp EF Humans(33%),114 patients with HFr EF(44%),58 patients with HFmr EF(23%),and 18 patients died in the hospital.According to the medical records,three groups of demographic data,past disease history,and personal history were recorded.The blood pressure,pulse,biochemical examination results,the ejection fraction of the heart color ultrasound,the size of the left atrial diameter,and information on the use of drugs outside the hospital were collected.The data was analyzed using SPSS 22.0 statistical software.Results: 1.In the three groups of patients with heart failure,HFr EF were mainly caused by old myocardial infarction while HFp EF patients were caused by ischemic heart disease;HFmr EF patients had the same two causes and similar proportions.2.In the three groups,among the baseline characteristics and laboratory tests,the proportion of males in HFr EF patients was higher,the lowest among HFp EF patients,and the HFmr EF patients were somewhere in between;HFp EF patients were older;HFr EF patients had lower admission contractions.Pressure,higher pulse rate and larger left atrium;both HFr EF and HFmr EF patients had higher NTpro-BNP levels.3.In the comparison of comorbidities in the three groups,patients with HFr EF had more history of hypertension;patients with HFp EF were more likely to have COPD and atrial fibrillation;patients with HFmr EF and HFr EF were more likely to have old myocardial infarction,and fewer patients with HFp EF.4.Among the three groups of oral drug comparisons,HFr EF and HFmr EF patients included more ACEI(ARB or ARNI)in long-term oral drugs;more patients with HFr EF orally included AA,"Golden Triangle" and loop diuretics,HFmr EF patients Secondly,patients with HFp EF were the least;patients with HFr EF received more oral digoxin,and the other two groups were less.5.Comparison of in-hospital survival status of all patients,hospitalized death patients had shorter hospital stays,lower systolic blood pressure,diastolic blood pressure and LVEF,higher NTpro-BNP levels and white blood cell counts,more acute myocardial infarction and renal insufficiency,Less combined with high blood pressure,and more intravenous incinerators.6.Patients with heart failure were followed up for an average of 9 months after discharge.The KCCQ-12 questionnaire was used to evaluate the quality of life.There was no significant difference in the scores of the three groups.7.Three groups of patients with heart failure were followed up for an average of 9 months after discharge.Log rank analysis showed significant difference in out-of-hospital survival rate(P=0.018).Kaplan-Meier survival analysis curve suggested that three groups of patients were outside the hospital within 6 months.Survival rate was not significantly different and survival rate was higher;after 6 months of discharge,the survival rate of the three groups decreased,the survival rate of the HFr EF group was the lowest,and the survival rate decreased with time;the survival of the HFmr EF group The rate was between the other two groups,but the rate of survival decreased with time was the slowest;the survival rate of the HFp EF group was the highest,but the survival rate decreased with time.Conclusions: 1.The main cause of heart failure in the HFr EF group was old myocardial infarction,and the HFp EF group was non-infarction ischemic heart disease.The proportion of the above two was similar in the HFmr EF group.This result explains to some extent the phenomenon that some clinical features of patients in the HFmr EF group are between the HFr EF and HFp EF groups.2.Patients with HFr EF have more men,have lower systolic blood pressure and higher pulse rate,larger left atrium and higher NTpro-BNP levels;more have a history of hypertension,and more oral "golden triangle",Drugs such as loop diuretics and digoxin.The results suggest that the HFr EF group has more obvious changes in cardiac structure,and the heart pump function is worse.The medication is relatively more in line with the guidelines and more comprehensive 3.HFp EF has higher admission systolic blood pressure,more comorbidities,more patients with atrial fibrillation,fewer patients with myocardial infarction and less oral administration of loop diuretics and digoxin.It is suggested that comorbidities may be involved in the formation of heart failure in the HFp EF group to some extent.4.Patients with HFmr EF are more likely to have HFp EF patients at baseline,while NTpro-BNP levels and medications are more likely to be between HFp EF and HFr EF.It is suggested that HFmr EF is a subtype of heart failure,and the clinical features are not simply between the other two types of heart failure,suggesting its heterogeneity and complexity.5.Patients which died in the hospital have worse cardiac pump function,and often have complications such as infection,acute myocardial infarction and renal insufficiency,and more intravenous incinerators are used in hospitals.6.patients with heart failure were followed up for an average of 9 months after discharge.The KCCQ-12 questionnaire was used to evaluate the quality of life.There was no significant difference in the scores of the three groups.This result may be related to the length of follow-up after discharge and partial loss of follow-up.7.Three groups of patients with heart failure were followed up for an average of 9 months after discharge,and there was a significant difference in the out-of-hospital survival rate.The out-of-hospital survival rate of patients within 6 months after discharge was not significantly different and the survival rate was higher.After 6 months,the survival rate of the three groups decreased,the survival rate of the HFr EF group was the lowest,and the survival rate of the HFp EF group was the highest.Time to postpone the rate of survival is faster.More detailed data can be collected for multivariate COX analysis of three groups of patients to further identify risk factors associated with each heart failure subtype.