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Prevalence,clinical characteristics,outcomes and risk factors of heart failure with preserved ejection fraction in patients with coronary heart diseaseObjective: To study the prevalence,clinical characteristics,one-year prognosis and prognostic factors of heart failure with preserved ejection fraction(HFpEF)and ejection fraction reduction(HFrEF)in patients with coronary heart disease(CAD).Methods: From January 1,2010 to December 31,2012,9788 patients with coronary heart disease were enrolled from four clinical centers.3872 patients with heart failure were screened out.According to left ventricular ejection fraction,patients with heart failure were divided into ejection fraction retention group(LVEF < 50%,HFpEF),median ejection fraction group(40% < LVEF < 50%,HFmrEF)and ejection fraction reduction group(LVEF < 40%,HFrEF).Among them,the combination of HFpEF and HFmrEF is called the retention of contractilefunction(PSF,EF? 40%)group.By comparing the clinical characteristics,1-year mortality and readmission rate of patients with central failure in PSF vs HFrEF group and HFpEF vs HFmrEF group,the prevalence,clinical characteristics,prognosis and risk factors of patients with ejection fraction preservation heart failure were analyzed.Results: The prevalence of ejection fraction preservation heart failure was higher in patients with coronary heart disease.47% of patients with coronary heart disease had heart failure with preservation of systolic function.Compared with HFrEF group,PSF group had older age,more women,hypertension,diabetes mellitus,atrial fibrillation,chronic obstructive pulmonary disease,more coronary artery lesions(25.2% vs17.0%);BNP and CK-MB levels were significantly lower(503.2±92.6 vs924.1±81.4;23.6±10.8 vs 40.8±10.2);ACEI/ARB,diuretics use rate was lower,CCB utilization rate was significantly higher(28.6% vs 24.2%,P = 0.00).The comparison of symptoms and signs between the two groups showed that the HFrEF group had more patients with paroxysmal dyspnea at night(31.5% vs 24.2%,P = 0.00)and fewer signs of ankle edema(56.6% vs 66.7%,P = 0.00).There was no significant difference in other symptoms and signs.The prognosis comparison between the two groups showed that there was no significant difference in hospitalization days between the two groups.The mortality in HFrEF group was significantly higher than that in PSF group.There was no significant difference in 1-yearmortality and 1-year readmission rate between the two groups;nor was there any significant difference in psychogenic mortality and readmission rate.The clinical characteristics of HFmrEF subgroup and HFpEF subgroup were further compared in patients with PSF.The results showed that there was no significant difference between the two groups(P > 0.05).There was no significant difference in hospitalization days.There was no significant difference in hospital mortality between the two groups.There was no significant difference in 1-year mortality and re-hospitalization rate;and there was no significant difference in psychogenic mortality and re-hospitalization rate.In multivariate analysis,three coronary artery lesions and age were predictors of mortality risk(P < 0.001).Conclusion: The prevalence of ejection fraction-preserving heart failure is high in patients with coronary heart disease.Aging,women,hypertension and atrial fibrillation are the risk factors of ejection fraction-preserving heart failure.The readmission rate and mortality rate of ejection fraction-preserving heart failure group are similar to those of ejection fraction-reducing heart failure group.The severer the degree of myocardial ischemia,the higher the mortality rate.Three vessel lesions and age were independent predictors of mortality risk.Part ?: The effects of TaiChi on cardiopulmonary function and hemodynamics in patients with heart failure with preserved ejectionfractionAIM: To observe the effects of Taijiquan exercise rehabilitation on cardiopulmonary function and hemodynamics in patients with ejection fraction preserved heart failure(HFpEF),and to compare the differences between Taijiquan and fast walking hemodynamics,so as to analyze the possible benefit mechanism of Taijiquan.Methods: From March 1,2017 to June 30,2017,28 patients with heart failure with ejection fraction preservation were enrolled in the cardiac rehabilitation clinic of Peking University People's Hospital.They were trained in Taijiquan for 12 weeks,three times a week,30 minutes each time.Before and after the training,cardiopulmonary exercise test and non-invasive cardiac output test were used to collect ventilation volume(VE),peak oxygen uptake(VO2 peak),cardiac output(CO),ejection fraction(EF),heart rate(HR),blood pressure(BP),cardiac work index(LCWi)and arteriovenous oxygen content difference(Da-vO 2)and other indicators,respectively,to compare the changes before and after the training of TaiChi.At the 12-week node,subjects were assigned to perform TaiChi exercise cardiopulmonary test and treadmill exercise cardiopulmonary test,and to further compare the hemodynamic differences between TaiChi and fast walking.RESULTS: This is was a self-control study.After 12 weeks of TaiChi exercise,VO2 peak increased significantly(25.24±5.43 vs 21.48±5.96,P < 0.05),resting heart rate and systolic pressure decreased(69±6.03 vs 72.71 ±8.32;106.43±14.28 vs 114.00±10.05),PHQ depression score and GAD anxiety score decreased(4.29±3.27 vs 7.43±8.15;3.43±1.83 vs 6.57±1.34).The standing time of one leg increased(10.86±5.28 vs6.00±3.42),and the difference was statistically significant,P values were less than 0.05.Compared with flat fast walking,LCWi of TaiChi at the same heart rate was significantly lower than that of fast walking(4.6±1.1vs 8.86±4.19),Da-vO2 was significantly higher than that of fast walking(113.26±39.87 vs 82.18±24.13);HR(95.9±19.07 vs 121.5±28.88)and LCWi(4.44±0.9 vs 7.48±2.37)of Tai Chi at the same oxygen intake were significantly lower than that of fast walking(171.88±79.28±20.70).The difference was significant(P < 0.05).Conclusion: 1.Tai Chi exercise can significantly improve the cardiopulmonary function and quality of life of patients with heart failure with ejection fraction preservation.2.Tai Chi can achieve the same exercise load as fast walking with smaller heart work.It is an alternative form of exercise rehabilitation for the elderly,weak and poor cardiac function.3.The possible benefit mechanism of Tai Chi is related to the improvement of Da-vO2. |
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