Clinical Study Of Noninvasive Hemodynamic Assessment In Patients With Heart Failure With Preserved Ejection Fraction

Heart failure with preserved ejection fraction(HFpEF)is a left ventricular ejection fraction that is normal or near normal,and its incidence and prognosis have no significant differenceis compared with heart failure with reduced ejection fraction(HFrEF).Unfortunately,in the past 3 dacades,we have made great progress in the diagnosis and treatment of HFrEF,but the same measures applied to HFpEF patients,and did not get the desired results.Compared with HFrEF,HFpEF pathophysiological mechanism is more complex,so its clinical manifestations are relatively diverse.Biometric impedance based noninvasive hemodynamic detection is a simple,noninvasive,repeatable,real-time monitoring of hemodynamic methods.it a high sensitivity index in evaluation of the hemodynamic changes in patients with heart failure.This study was based on noninvasive hemodynamics testing techniques to assess hemodynamics in HFpEF patients,with hope to early detection hemodynamic changes in patients with HFpEF and Find the indication following the hemodynamic changes.Thus providing more guidance basis for early diagnosis and assessment of disease and effective treatment of HFpEF.Randomly selected patientsoutpatient or inpatient treatment in our hospital Heart Center from 2015-04 to 2016-11,according to the left ventricular diastolic function is divided into: heart failure with preserved ejection fraction(HFp EF)group and left ventricular diastolic dysfunction without heart failure symptoms(LVDD)group.In addition,we selected 35 healthy volunteers in our hospital as control group.All patients underwent brain natriuretic peptide(BNP),tissue Doppler echocardiography and noninvasive hemodynamic testing.Selected the tissue Doppler echocardiographic indicators: left atrial diameter(LAD),left ventricular end diastolic diameter(LVEDd),fractional shortening(FS),left ventricular ejection fraction(LVEF),pulsed Doppler measurements two(E peak),diastolic late filling rate(A peak),measurement of early diastolic mitral annulus velocity(E '),and calculate the E/E ' value.Noninvasive hemodynamic detection measured: near ventricular ejection period / ventricular ejection period(Q-B / B-X),ventricular contractility index(HI),atrial contraction wave amplitude(WA)ventricular diastolic waves amplitude(O),ventricular systolic(LC),diastolic function index(O/LC),cardiac index(CI),total peripheral resistance(TPR),aortic vascular compliance(AC)and pulmonary hemodynamics reflecting pulmonary circulation and right ventricular function(Q-BI),ventricular ejection fraction(B-YI),myocardial tension index(Q-B/B-Y),right ventricular systolic wave(HS),differential map room amplitude),Mean pulmonary arterial pressure(PAP),Right heart failure index(P2-Y),I phase area(S1)and so on.All experimental data were expressed as(x ±s).SPSS17.0 software was used for statistical analysis,the measurement data was expressed as(x ±s).The independent samples were used for t test or nonparametric rank sum test.Rate comparison with ?2 test,the test level ? = 0.05,P <0.05 respected the difference was statistically significant.Comparison of basal data and cardiac ultrasound Doppler results:There was no significant difference in age,sex,height,heart rate and LVEDD,and there was no significant difference between E / A and HFpEF in LVDD group and HFpEF group(P> 0.05),It was statistically significant between the groups remaining indicators(P <0.05 or P <0.01).Comparison of noninvasive hemodynamics test results: In addition WA / C was no significant difference between the control group and outside the group HFpEF,There were statistically significant differences among the other groups(P < 0.01).Comparison of noninvasive pulmonary hemodynamics test results:There were significant differences between the three groups(P < 0.05 or P < 0.01).Correlation analysis of cardiac/pulmonary hemodynamic parameters with plasma BNP was performed: Detecting cardiac hemodynamic indices O,LC O/LC,HI,TPR,CI,AC and pulmonary hemodynamics detected index Q-BI,B-YI,PAP,QB / BY,P2-Y,HS,S1 are with plasma BNP levels increased,there was a significant correlation with plasma BNP,and the correlation was statistically significant.PlasmaBNP level had positively correlated withQ-B/B-X(R=0.682,P<0.01)?TPR(R=0.636,P<0.01)?O(R=0.616,P<0.01)?O/LC(R=0.742,P<0.01)?Q-BI(R=0.629,P<0.01)?PAP(R=0.623,P<0.01)?Q-B/B-Y(R=0.664,P<0.01);while there had negatively correlated with HI(R=-0.750,P<0.01)?LC(R=-0.616,P<0.01)?CI(R=-0.844,P<0.01)?AC(R=-0.783,P<0.01)?B-YI(R=-0.636,HS(R=-0.568,P<0.01)?RC(R=-0.510,P<0.01)?P2-Y(R=-0.744,P<0.01)?SS(R=-0.696,P<0.01)and S1(R=-0.610,P <0.01).Correlation analysis of cardiac/pulmonary hemodynamic parameters with E/E'was performed:Cardiac hemodynamics detection index: Q-B/B-X?HI?TPR?CI?AC and pulmonary hemodynamics detection index: Q-BI,B-YI,PAP,QB/BY,P2-Y,HS,with E/E'ratio increases were significantly correlated,and the correlation had statistically significant(P<0.01).E/E' level had positively correlated with Q-B/B-X(R=0.372,P<0.01)?TPR(R=0.562,P<0.01)?Q-BI(R=0.516,P<0.01)?PAP(R=0.413,P<0.01)?Q-B/B-Y(R=0.649,P<0.01);while there had negatively correlated with HI(R=-0.590,P<0.01)?LC(R=-0.726,P<0.01)?CI(R=-0.657,P<0.01)?AC(R=-0.658,P<0.01)?B-YI(R=-0.532,P<0.01)?HS(R=-0.414,P<0.01)?RC(R=-0.383,P<0.01)?P2-Y(R=-0.665,P<0.01)?SS(R=-0.569,P<0.01).Correlation Analysis between E / A and WA Wave,WA / C and between E / E ' and O wave,O / C:E / A was negatively correlated with WA(R =-0.524,P <0.01),WA /L C(R =-0.594,P <0.01),while E / E 'and O(R = 0.789,P <0.01),O /LC(R = 0.799,P <0.01)was positively correlated.Through the above study we can conclusion that:first of all,,HFpEF patients in addition to cardiac remodeling,biomarkers change,we use hemodynamics detection method can also be found in the early response to ventricular diastolic function indicators O / LC and WA / LC,ventricular systolic function index QB / BX and LC,pulmonary arterial pressure and other indicators of changes.Secondly,noninvasive hemodynamic detection technology used to assess the ejection fraction retention of heart failure in patients with hemodynamic changes,the results are reliable,sensitive,simple and noninvasive,suitable for clinical applications..Lastly,the study size is small,therefore more sample studies are needed to confirm the results of this study.