Clinical Study Of Prognosis In H₂FPEF Score And Patients With Heart Failure With Preserved Ejection Fraction

Background:Heart failure is the end-stage manifestation of various cardiovascular diseases,and it is one of the biggest challenges in cardiovascular field in the 21st century.ESC in 2016 promulgated the acute and chronic heart failure diagnosis and treatment guidelines,the heart failure according to the values of left ventricular ejection fraction?LVEF?is divided into three categories:EF reserved for ejection fraction of 50%or more?HFpEF?,heart failure EF40-49%for ejection fraction of intermediate value?HFmrEF?and heart failure EF<ejection fraction 40%decrease of heart failure?HFrEF?^[1].In recent years,studies have found that the detection rate of heart failure?HFPEF?with ejection fraction retention increased from 41%to 56%^[2].The pathophysiological mechanism of HFpEF is complex and the incidence population is different.Currently,there is no treatment method that can significantly improve the prognosis of HFpEF,making the diagnosis and treatment of HFpEF challenging.In 2018,Circulation proposed a new HFpEF diagnostic score,that is,H₂FPEF score?H obesity BMI?30kg/m²,?2 kinds of antihypertensive drugs 1 point each,F paroxysmal or persistent atrial fibrillation 3 points,P pulmonary artery pressure>35mmHg 1 point,E age>60 years old 1 point,F peak pressure that is doppler echocardiography E/E'>9 1 point;?9 points in total?.According to this score,HFpEF can be evaluated for people with dyspnea.This score found that the probability of HFpEF increased by 1 unit?OR 1.98?.95%CI 1.74-2.30;The area under the curve was0.841?P<0.0001?.Patients with H₂FPEF score of 6-9 were highly suspected of HFpEF.At present,there is no research on the correlation between this score and prognosis.The main purpose of this study is to evaluate the correlation between H₂FPEF score and prognosis in HFpEF patients.Methods:A total of 476 patients admitted to dalian medical university hospital and diagnosed as HFpEF from January 1,2015 to April 31,2018 were selected as research objects.Detailed collection of selected patients with general clinical data,including the history,clinical characteristics,such as medications,line related to check blood biochemical indicators,dynamic electrocardiogram and echocardiography?ultrasonic cardiogram,UCG?examination.The included patients were divided into three groups according to H₂FPEF score:low group?H₂FPEF 0-1 score?;Intermediate group?H₂FPEF 2-5 points?;High score?H₂FPEF 6-9?.A mean follow-up of 27.5 11.3months was conducted to compare the differences in clinical data between the three groups.SPSS 24.0 statistical software was used for data processing.The counting data were tested by Fisher's exact test and 2 test.The measurement data of the non-normal distribution are expressed as M?Q1,Q3?.Kruskal-wallis test is applied to the comparison between groups,and kw-single-factor ANOVA test is used to analyze the comparison between groups.The measurement data of normal distribution were expressed as x s,and ANOVA test was used to analyze the comparison between multiple groups.All-cause mortality and readmission rate were used as endpoint events to determine the prognosis.Kaplan-meier method was used to draw the survival curve and Cox regression analysis was performed.Results:1.Comparison of clinical characteristics and general baseline data after different H₂FPEF scoring groups:The age and BMI of the H₂FPEF score?6-9 points?group were higher than that of the H₂FPEF score?0-1 points?group and the H₂FPEF score?2-5 points?group?P<0.05?.The incidence of atrial fibrillation/atrial flutter,coronary heart disease and hypertension in the H₂FPEF score?6-9 points?group was higher than that in the H₂FPEF score?0-1 points?group and H₂FPEF score?2-5 points?group?P<0.05?.UA,Na,left entricular meridian,E/E'and RVSP in the H₂FPEF score?6-9 points?group were higher than those in the H₂FPEF score?0-1 points?group and H₂FPEF score?2-5 points?group?P<0.05?.2.Prognostic analysis of H₂FPEF score in HFpEF patients:a total of 476patients were followed up for 27.5 11.3 months.There were 262 patients in the H₂FPEF score?2-5 points?group,and 29 patients died.There were 47 patients in the H₂FPEF score?0-1 points?group,and 3 patients died.Survival curves of the three groups were drawn,and there were significant differences among the logarithmic rank test groups?P=0.001?.Compared with the H₂FPEF score?0-1?group and the H₂FPEF score?2-5?group,Cox regression model showed that all-cause mortality was significantly increased in the H₂FPEF score?6-9?group?RR 0.195,95%ci 0.059-0.641,P=0.007?.RR 0.493,95%CI 0.295-0.824,P=0.007?.There was no statistically significant difference in the rate of worsening heart failure readmission between the three groups.3.Independent prognostic factors of HFpEF patients:Cox multivariate regression analysis showed that age,BMI,myocardial infarction,diabetes mellitus,UA,left atrial diameter and H₂FPEF score were independent predictors of all-cause death in HFPEF patients?P<0.05?.Conclusions:1.Hypertension,diabetes were higher in the H2FPEF group than in the low group and the middle group.2.The H₂FPEF score with high group mortality?18.6%?was significantly higher than the middle group?11.1%?and the low group?6.4%?.3.Age,BMI,myocardial infarction,diabetes mellitus,UA,left atrial diameter,and H₂FPEF score were independent predictors of all-cause mortality in HFPEF patients.H₂FPEF score can be used as an evaluation index to predict the prognosis of HFPEF patients.