Analysis Of The Clinical Characteristics Of Heart Failure With Mid-range Ejection Fraction

Objective:2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure,the left ventricular ejection fraction(LVEF)from 40% to 49% of chronic heart failure was defined as the heart failure with mid-range ejection fraction(HFmr EF),To distinguish between two other types of chronic heart failure,In other words,ejection fraction decreased heart failure(EF< 40%)and ejection fraction retained heart failure(EF≥50%).It established HFmr EF as an independent type of heart failure,the current research on this new type is relatively scarce.On the one hand,in order to promote the HFmr EF of clinical characteristics,etiology and complications,echocardiography,drug therapy research;On the other hand,due to the lack of relevant research data and clinical evidence,in order to determine whether HFmr EF was an independent entity or an intermediate transitional stage between HFmr EF and HFr EF,to rich heart failure database in Tianjian.Methods:This study used a multicenter,retrospective,cross-sectional approach,Investigating and Analysising of chronic heart failure patients hospitaed in 9 Grade III Hospitals in Tianjin(These included 6 urban hospitals and 3 suburban hospitals,covering a wide range of areas with a certain degree of representativeness)From March 2014 to February 2016 using self-made CHF questionnair,patients with heart failure of NYHA cardiac function grade II-IV were 1902.there were 806 patients with HFr EF,there were 806 patients with HFmr EF,there were 410 patients with HFp EF.To analyze the basic characteristics,etiology and associated diseases,cardiac function,echocardiography,drug therapy of HFmr EF patients,and the difference between them and the patients with HF.Results:1.The baseline feature: There were 806 patients with HFmrEF,the proportion of HFmr EF was 36.1%,the proportion of male was 62.0%,the proportion of female was 38.0%,and the proportion of female about HFmr EF was similar to HFr EF.Compared with HFp EF,HFmr EF was younger and more likely to be male(P<0.05).The most common cause was coronary heart disease.2.The proportion of age distribution: The proportion of HFmr EF patients did not change with age(P>0.05).The proportion of HFr EF patients decreased with the increase of age(P<0.05),and the proportion of HFpEF patients gradually increased with age(P<0.05).3.Cardiac function distribution: The proportion of NYHAII-IV grade in HFmr EF patients was 33.7%,43.4% and 22.9%,respectively.The proportion of NYHAII grade in HFmr EF was significantly higher than HFr EF with HFp EF patients(P<0.05);The proportion of the NYHAIII grade in the HFmr EF patients was significantly lower than the HFr EF with HFp EF(P<0.05);There was no significant difference between the three groups in the NYHA IV(P>0.05).4.Etiology and complications:The first eight causes and complications of HFmr EF patients were coronary heart disease,hypertension,diabetes,pulmonary infection,cerebrovascular disease,renal insufficiency,atrial fibrillation and anemia.The prevalence of coronary heart disease,diabetes mellitus and atrial fibrillation in patients with HFmr EFwas not significantly different with the HFr EF with HFp EF patients(p > 0.05);there was no significant difference in the prevalence of pulmonary infection,cerebrovascular disease,renal insufficiency,anemia and hypoproteinemia between HFmr EF and HFr EFpatients(P >0.05),and was significantly lower than the HFp EF patients(P < 0.05),the prevalence of pulmonary infection,cerebrovascular disease,renal insufficiency,anemia and hypoproteinemia in patients with HFmr EF were similar to HFr EF;the prevalence of hypertension in HFmr EF patients was similar to the HFp EF patients(p > 0.05)and was higher than the HFr EF patients(p < 0.05);It shows that the clinical characteristics of HFmr EF patients are between HFr EF and HFp EF,and are more similar to HFr EF.5.The proportion of LVEF between 40% and 45% in HFmr EF was78%,the proportion of LVEF40% was the highest(21%).6.Echocardiography:RA、RV、LA、LV was(23.44±17.63)、(16.89±12.72)、(40.70±8.44)、(53.79±10.44)millimetre.7.Drug treatment: the HFmr EF patients about the utilization rate ACEI、ARB、 β receptor blocker、 CCB、energy metabolism drug、 ACEI / ARB、aldosterone receptor antagonist、nitrate ester、antiplatelet drugs and anticoagulants was similar to HFr EF patients(P>0.05),the HFmr EF patients about the utilization rate of diuretics and digitalis was similar to HFp EF patients(P>0.05),indicating that the utilization rate of HFmr EF patients was similar to that of HFr EF patients,except diuretics and digitalis.Conclusion:1.The LVEF range of HFmr EF is only 40%-49%,and its proportion in the three types of heart failure is 36.07,which is not low;The proportion of HFmr EF patients did not change with age increasing.2.Patients with HFmr EF were more similar to HFr EF,such as the proportion of women,age,etiology and complications.The distribution of LVEF of HFmr EF was mainly concentrated in the center of 40%to 45%.It speculates that many clinical features of HFmr EF may be closer to the HFmr EF.