Clinical Characteristics Of Patients With Preserved Ejection Fraction

Objective:1.To compare the clinical characteristics of heart failure patients with preserved(HFPEF)and reduced(HFREF)ejection fraction.2.Clinical characteristics of three different types of patients with ejection fraction preserved heart failure and acute coronary syndrome.Methods:1.A total of 348 patients with heart failure from September 2015 to November 2017 were retrospectively analyzed.According to left ventricular ejection fraction(EF),the patients were divided into two groups: HEPEF(EF?45%,185 cases,mean age(74.6 ± 1.5)years old,82 males and 103females)and(HFREF,EF <45%,163 cases,mean age(64.8± 2.2)years old,including 104 males and 59 females).Recorded the clinical data of two groups including general information,underlying etiology,biochemical indexes,Echocardiography results,medication in detail.2.According to the clinical symptoms,electrocardiogram,coronary angiography and other results of heart failure patients with preserved ejection fraction associated with acute coronary syndrome were divided into unstable angina group,non-ST elevation myocardial infarction group,ST elevated myocardial infarction group,compared the three groups of clinical features.Results:Among the 348 patients,there were 134 patients with coronary heart disease,93(26.7%)patients with dilated cardiomyopathy,53(15.2%)patients with hypertensiveheart disease,29(8.3%)patients with pulmonary heart disease,32(9.2%)patients with rheumatic heart disease,7(2.0%)cases of heart failure caused by atrial fibrillation.1.Patients with HFPEF are elder[(74.6±1.5)years old vs(64.8±2.2)years old,t=3.598,P=0.015],more women(60.7%vs29.9%,?2 =16.410,P=0.000),lower body weight[(62.7±13.4)vs(68.6±14.9),t=-2.395,P=0.018],less likely to have renal insufficiency(36.7%vs53.6%,?2=4.670,P=0.041),and more likely to have hypertension and atrial fibrillation(47.6%vs13.8%,?2 =23.107,P=0.000).The HFPEF group had higher admission systolic blood pressure than HFREF group[(131.2±22.2)mmHg vs(124.1±24.9)mmHg,t=2.058,P=0.041].There was no significant difference regarding Coronary heart disease,diabetes.HFPEF group was lower than HFREF group in BNP value[(874.2±912.3)pg/ml vs(835.2±1 490.4)pg/ml,t=-5.011,P=0.000]?hemoglobin value[(125.5±24.3)g/L vs(134.7±23.9)g/L,t=-2.460,P=0.015];ESR was faster in patients with HFPEF than in those with HFREF[(28.0±25.6)mm/h vs(16.9±14.9)mm/h,t=2.486,P=0.017];Lower uric acid values in HFPEF group than in HFREF group[(358.9±120.6)umol/Lvs(415.9±153.4)umol/L];There was no significant difference between the two groups regarding homocysteine,urea nitrogen,urinary microalbumin,serum potassium,serum sodium.The HFPEF group had a smaller left ventricular size than HFREF[(50.9±6.4)mm vs(67.3±8.5)mm,t=-11.303,P=0.000];Patients with pulmonary hypertension in HFPEF group were more than HFREF group(30%vs50%,P=0.016)?2.RAS blockers(52.4%vs86.2,?2=23.107,P=0.000),spironolactone(72.6%vs88.5%,?2=6.926,P=0.011),?-blockers(57.1%vs75.9,?2=6.739,P=0.015),statin(38.1%vs54%,?2=4.362,P=0.046)were used more in HFREF group,while calcium channel blocker(38.1%vs13.8%?2=13.208,P=0.000)and warfarin(16.7%vs5.7%,?2=2.159,P=0.129)were used more in HFPEF group.No difference was found in the use of in insulin,diuretic,nitrate,digoxin,low molecular weight heparin for both groups.3.In HFPEF patients with coronary heart disease,the proportion of anterior descending coronary artery stenosis at Grade III and above was more than that of circumflex and right coronary artery,and electrocardiogram suggested that the proportion of anterior wall infarction was significantly higher than that of the inferior and posteriorwalls.4.UA group had fewer cases of hyperuricemia than STEMI group(30%vs50%,P< 0.05);UA group and STEMI group had lower BNP than NSTEMI group(652.4±1266.8 vs 2034.3±1101.1,P<0.05;595.3±592.6 vs 2034.3±1101.1,P<0.05);More females in NSTEMI group than UA group(85.7% vs.71.4%,P<0.05).Conclusion:1.Patients with older women,low body weight,and high systolic blood pressure are prone to HFPEF;patients with hypertension,atrial fibrillation,and pulmonary hypertension are prone to HFPEF,and the proportion of HFREF patients with coronary heart disease and type 2 diabetes is not significantly different from that of HFREF;HFPEF patients Hemoglobin and BNP levels are lower,and ESR is faster;normal or mild elevation of uric acid is a risk factor for HFPEF;homocysteine can also cause HFPEF;2.In terms of treatment,patients in the HFPEF group had lower rates of use of RAS blockers,spironolactone,aspirin,beta-blockers,and statins compared with the HFREF group,calcium channel blockers,and warfarin.The rate is higher.Therefore,different types of heart failure require different methods of diagnosis and treatment,treatment and prevention.3.In HFPEF patients with coronary artery disease,the coronary lesions were mainly located in the anterior descending coronary artery,and the infarcted sites in the STEMI group were mostly in the anterior wall.4.There were more female patients in the UA group and the STEMI group;more STEMI patients with hypertension,hyperuricemia,and renal insufficiency;and higher BNP levels in the NSTEMI group.