Analysis On The Risk Factors Of Heart Failure With Preserved Ejection Fraction For Acute Myocardial Infarction Patients After PCI

ObjectiveThis study collected general clinical data of patients who were diagnosed with acute myocardial infarction(AMI)for the first time through percutaneous coronary angiography and received percutaneous coronary intervention(PCI),and then analyzed the risk factors of heart failure with preserved ejection fraction(HFpEF)after PCI in patients with first-time AMI.It helps clinicians to identify the occurrence of HFpEF early in patients with normal left ventricular ejection fraction,correctly diagnose and timely take corresponding intervention measures to reduce the prevalence rate,delay the development of the disease,make patients have the clinical advantage of the disease and improve the prognosis.MethodsThe study collected 194 patients from January 2017 to December 2018 in the Department of Cardiovascular Medicine(HuangGu hospital area)of the Second Hospital Affiliated to Shenyang Medical College for admission who were diagnosed with first-time AMI through percutaneous coronary angiography and received PCI.194 patients were enrolled and divided into the HFpEF group(n=67)and the non-HF group(n=127).Recorded the age,gender,previous history(coronary heart disease,hypertension,diabetes,hyperlipidemia,stroke,and smoking),heart rate,systolic blood pressure,diastolic blood pressure,type of AMI,the number of diseased-vessels,height,weight,body mass index(BMI),aspartate aminotransferase(AST),serum creatinine,triglycerides,total cholesterol,N-terminal B-type natriuretic peptide precursor(NT-proBNP),cardiac troponin T,MB isoenzyme of creatine kinase(CK-MB),left ventricular ejection fraction(LVEF),left atrial diameter(LAd),left ventricular end-diastolic dimensions(LVEDd),left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),interventricular septal thickness(IVST)and other clinical data.All data were analyzed by SPSS 24.0 statistical software package.The continuous variables subject to normal distribution were expressed as mean ± standard deviation,and independent-samples T test was used for comparison between groups.The continuous variables that did not follow the normal distribution were represented by the median(quartile),and Mann-Whitney U test was used for comparison between groups.The categorical variables of the enumeration data were expressed as the patients’ number of cases(rate)in each group,and then analyzed using the chi-square test.Multivariate logistic regression analysis was performed on statistically significant variables,and receiver operator characteristic curve(ROC curve)was plotted.P <0.05(both sides)was statistically significant.ResultsThe incidence rate of HFpEF in first-time AMI patients after PCI in our hospital was 28.9%,and HFpEF patients accounted for 66.7% of heart failure patients.Age,history of diabetes,STEMI cases,BMI,AST,urea nitrogen,NT-proBNP,troponin T,CK-MB,LVEF,LAd,LVEDd,LVEDV,LVESV and the number of diseased-vessels in the HFpEF group were significantly higher than those in the non-HF group,and the differences were statistically significant(P<0.05).The differences between the other variables were not statistically significant(P>0.05).After univariate analysis of the related factors that may affect the occurrence of HFpEF in first AMI patients after PCI,multivariate logistic regression analysis was performed on the variables with statistical differences.The test level α of the introduced variables was 0.05.Two factors were included in the model: the number of diseased-vessels(OR=2.464,95%CI:1.446~4.197,P=0.001)and the level of NT-proBNP(OR=1.001,95%CI:1.000~1.001,P=0.000),the ROC curve was plotted.The area under the curve of the number of diseased-vessels and HFpEF was 0.686(95%CI: 0.608-0.764,P=0.000),and the area under the curve of NT-proBNP and HFpEF was 0.812(95%CI: 0.743-0.880,P=0.000),both of which were statistically significant.The optimal cutoff value of number of diseased-vessels for predicting the occurrence of HFpEF in first-time AMI patients after PCI was single vessel lesion.The sensitivity and specificity were 0.791 and 0.528,respectively.The optimal cutoff value of NT-proBNP for predicting the occurrence of HFpEF in first-time AMI patients after PCI was 883.45ng/L.The sensitivity and specificity were0.701 and 0.858,respectively.Conclusions1.The incidence rate of HFpEF in first-time AMI patients after PCI in our hospital was 28.9%,and HFpEF patients accounted for 66.7% of heart failure patients.2.The number of diseased-vessels and the level of NT-proBNP are the independent risk factors for HFpEF in first-time AMI patients after PCI.3.Both the number of diseased-vessels and the level of NT-proBNP have predictive value for the occurrence of HFpEF in first-time AMI patients after PCI.The level of NT-proBNP with high sensitivity and specificity has the high predictive value.