| BackgroundHeart failure is one of the complications of various cardiovascular diseases such as coronary heart disease,hypertension,heart valve disease,and cardiomyopathy.Heart failure is an important part of global chronic disease.The latest 2016 ESC guidelines for heart failure classify heart failure into three types based on Left Ventricular Ejection Fraction(LVEF),B-type Natriuretic Peptide(BNP)levels,and clinical signs and symptoms.The Three types heart failure are Heart Failure with Reduced Ejection Fraction(HFrEF,LVEF <40%),Heart Failure with preserved Ejection Fraction(HFpEF,LVEF ? 50%)and shots Heart Failure with mid-range Ejection Fraction(HFmr EF,LVEF 40%~49%).In recent years,most studies are focused on HFrEF and HFpEF.Few studies have reported on the clinical features of HFmrEF.ObjectiveThis article aims to explore the clinical features of patients with different ejection fractions of heart failure and provide reference for the diagnosis and treatment of chronic heart failure by analyzing general clinical data,laboratory tests,and features of coronary artery lesions in patients with different ejection fractions of heart failure.MethodsThis retrospective analysis include 282 cases who were diagnosed as heart failure and underwent coronary angiography(CAG)in Zhengzhou people's Hospital during January 2015 to October 2016.Depending on echocardiography and the level of BNP examination results,the 282 cases were divided into HFrEF(112 cases),HFmrEF(74 cases),and HFpEF(96 cases).The differences in clinical basic data such as age,gender,history of atrial fibrillation,and functional class were compared among the three groups.we compare the left atrial diameter,left ventricular end diastolic diameter,and left ventricular end-systolic diameter,left ventricle posterior wall thickness,and chamber Differences between Septal thickness to understand the difference in heart structure among the three groups.To understand coronary artery disease in patients with heart failure,the number of vascular lesions,gensini scores,and SYNTAX scores were compared.Results(1)The percentage of female subjects,and the incidence of hypertension,atrial in patients with HFrEF were significantly lower than that of HFpEF group(P <0.05).(2)The patients in HFrEF group combined with old myocardial infarction,was significantly higher than HFpEF group,the difference was statistically significant(P <0.05).(3)The percentage of female subjects in the HFrEF group were lower than those in the HFmr EF group(P < 0.05).(4)The classification of NYHA in HFpEF group was mainly(61.5%),?which was significantly higher than the other groups.The classification of NYHA in HFmrEF group mainly distributed in grade ?and ?(81%).NYHA class III and IV accounted for 83.1% of the HFrEF group.The difference between the three groups was statistically significant(P < 0.05).(5)The left atrium diameter,left ventricular end-diastolic diameter and left ventricular end systolic diameter in HFrEF group were significantly higher than those in HFmrEF and HFpEF groups,and the differences were statistically significant.(P <0.05).(6)The ventricular septal thickness and left ventricular posterior wall thickness in HFrEF group were significantly lower than those in HFmrEF and HFpEF groups,and the differences were statistically significant(P <0.05).(7)The left atrium diameter,left ventricular end-diastolic diameter and left ventricular end systolic diameter in HFmrEF group were significantly higher than those in HFpEF groups,and the differences were statistically significant(P <0.05).(8)The ventricular septal thickness and left ventricular posterior wall thickness in HFmrEF group were significantly lower than those in HFpEF group,and the differences were statistically significant(P <0.05).(9)Kruskal-Wallis H test was performed on the Gensini scores among HFrEF,HFmrEF,and HFpEF.The test result was: H = 17.846,P < 0.001.It can be considered that the Gensini scores differed among the three groups.After a pairwise comparison,there was no difference on Gensini scores between the HFrEF and HFmrEF groups(P=0.555).There was a difference on Gensini scores between HFrEF and HFpEF groups(P<0.001).There was a difference on Gensini scores between HFmrEF and HFpEF groups(adjusted P=0.039).(10)Kruskal-Wallis H test was performed on the SYNTAX scores among HFrEF,HFmrEF,and HFpEF.The test result was: H = 6.654,P=0.038.It can be considered that the gensini scores differed among the three groups.After a pairwise comparison,there was no difference on gensini scores between HFrEF and HFmrEF groups(P=0.631).There was a difference on gensini scores between HFrEF and HFpEF groups(P=0.03).There was no difference on gensini scores between HFmrEF and HFpEF groups(P=0.834).(12)The risk of coronary artery disease in patients with HFrEF is mainly low-risk and moderate-risk.The risk of vascular lesions in patients with HFp EF and HFmrEF was mainly low risk.Conclusions(1)The patients with HFrEF were combined with coronary heart disease and old myocardial infarction.The daily activities of patients in the HFrEF group were more severe than that in the other two groups.HFpEF is common in older women.patients with HFpEF were often associated with hypertension and atrial fibrillation.The clinical features of the HFmrEF group were between the HFrEF group and the HFpEF group.(2)The ventricular remodeling in patients with HFrEF is mainly eccentric remodeling.The ventricular remodeling in patients with HFpEF is mainly centripetal remodeling.Ventricular remodeling in patients with HFmrEF can be manifested both as concentric ventricular remodeling and as eccentric ventricular remodeling.From the cardiac morphology,HFpEF patients showed a significant increase in ventricular septal thickness and left ventricular wall thickness.The heart state of HFrEF patients showed an increase in the left atrium and ventricle,and a slight increase in the thickness of the posterior wall of the left ventricle.However,the thickness of the ventricular septum did not increase significantly.(3)The risk factors of heart failure such as UA,Hcy and BNP in group.HFrEF were higher than those in group HFmrEF and HFpEF.(4)The severity and complexity of coronary artery disease in HFrEF were heavier than those in the other groups. |
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