Clinic Study Of The Relationship Between The Heart Failure With Normal Ejection Fraction And Cardiac Remodeling

Background:In patients with chronic heart failure, the incidence is similar between heart failure with normal ejection fraction and heart failure with reduced ejection fraction, and the prognosis of HFNEF is not prior to HFREF's.At present, the diagnosis and therapeutic principle of HFREF are relatively definitive home and abroad, while it is still controversial in epidemiology, pathophysiological characteristics, diagnostic criteria, therapeutic principle and prognosis about HFNEF, at the same time fairly comprehensive observation and follow up to HFNEF are rare to see at home.Objective:To investigate cardiac remodeling variation trend, disciplinarian and clinic significance in HFNEF patients with differential cardiac functional grades.1. Compare LVPWTs and IVSDs in HFNEF patients with differential cardiac functional grades, to have knowledge of different cardiac functional grades' influences on LVPWTs and IVSDs to find the variation disciplinarian and analyze the clinical significance.2. Compare LADs in HFNEF patients with differential cardiac functional grades to learn about in different condition of cardiac functional grading the HFNEF's effect on left atrium, so as to get the variation disciplinarian and to have a analysis of the clinical significance.3. Compare RVDs in HFNEF patients with differential cardiac functional grades to learn about in different condition of cardiac functional grading the HFNEF's effect on RVDs to analyze the clinical significance.4. Compare the patients of HFNEF with the patients of HFREF in the following factors:LVPWTs IVSDs, LADs and RVDs, to highlight the influence of HFNEF on cardiac remodeling and analyze the clinical significance.5. To observe whether there is an increase of the incidence of the AF with the left atria getting larger, and analyze the clinical significance.Method:170 patients hospitalized in the cardiac department of the second hospital of Tianjin medical university for chronic heart failure from March to December 2010 are enrolled in. Basing on《2007 ESC a consensus on diagnosing heart failure with normal ejection fraction of left ventricle reaching by the associations of heart failure and ultrasound,the cases are divided into two groups, the experiment group and control group.1. The experimental group containing 102 patients with HFNEF sets an example,40 males and 62 females, age from 40 to90, the average age is 68.5±2.3, among which the primary diseases are hypertension (8 cases), coronary heart disease(5 cases), hypertension complicated with DM(10 cases), coronary heart disease complicated with DM(4 cases), hypertension complicated with coronary heart disease(40 cases), hypertension complicated with coronary heart disease and DM(35 cases).2. The control group includes 68 patients of HFREF,36 males and 32 females, age from 25 to 91 (mean age is 56.3±8.06), among which the original diseases are hypertension complicate with coronary heart diseases(15 cases), hypertension complicated with DM(10 cases), coronary heart disease complicated with DM(6 cases), hypertension complicated with coronary heart disease and DM(30 cases) and others(7 cases). The experimental group is divided into three subgroups according to NYHA:classⅡ(47 cases), classⅢ(40 cases), classⅣ(15 cases), and compare theirs LVPWT, IVSD, LAD and RVD. Meanwhile the control group is divided into three subgroups according to NYHA:classⅡ(10 cases), classⅢ(25 cases), classⅣ(33 cases). Compare patients of classⅣ(NYHA) of the experimental group with patients of classⅣ(NYHA) of the control group in four factors, which are LVPWT, IVSD, LAD and RVD.Result:1. Analyzing from general information, the patients with HFNEF show higher ratio of female, senility and history of hypertension than the patients with HFREF2. In patients of HFNEF NYHA classⅢ, the LVPWTs and IVSDs are larger than classⅡ(LVPWT:P=0.032;IVSD:p=0.029), and smaller than classⅣ(LVPWT: p=0.012;IVSD:P=0.023),and the discrepancies have statistical significance.3. The LADs of patients with HFNEF of NYHA classⅢare larger than classⅡ(P=0.037), and smaller than classⅣ(p=0.021), and the differences also have sense in statistics.4. In patients with HFNEF, the differences of RVDs between NYHA classⅢand classⅡ(P=0.078), and between classⅢand classⅣ(P=0.056),there are not statistical sense.5. Comparing with patients with HFREF of NYHA classⅣ, the patients with HFNEF show larger LVPWTs (P=0.001),IVSTs (P<0.001), and smaller RVDs(P=0.026), and the differences have statistical significance, while the differences of LAD (P=0.089) are not statistically significant.6. Comparing with patients with HFNEF of NYHA classⅢ, the incidence of AF is higher than HFNEF of classⅡ(P=0.034), and lower than HFNEF of classⅣ(p=0.023)7. In patients with HFNEF, the incidence of atrial fibrilation is higher with LAD getting bigger, which can be seen by comparing the groups LAD30-40mm with LAD≤29mm(P=0.036) and LAD≥40mm(p=0.021).8. There is no statistical significance in incidence of AF between HFNEF of NYHA classⅣand HFREF of classⅣ(p=0.089)Conclusion:1. The patients with HFNEF have higher percentage in advanced age, female and hypertension history versus the HFREF2. The greater of the cardiac functional grade, the higher of the influence of the HFNEF to cardiac remodeling.3. The HFNEF hardly affect the right ventricle.4. The incidence of AF gets higher with the increase of LAD.