| Research background and purpose:Heart failure?HF?is a serious manifestation or advanced stage of various heart diseases.At present,among the various causes of HF,coronary atherosclerotic heart disease?CHD?accounts for about 1/2-2/3,and has become the main cause[1-2].Since the 1990s,the treatment of chronic HF has undergone a major change,from short-term hemodynamic effects to long-term biological strategies of the heart,from cardiotonic,diuretic and vasodilator drugs to neuroendocrine inhibitors.Despite the great progress made in the treatment of HF,there are still high mortality rates and rehospitalization rate.China-HF study shows that 5.3%of hospitalized HF patients still die in China.HF of coronary heart disease is caused by severe myocardial ischemia,myocardial hibernation,myocardial stunning and scar formation after myocardial necrosis[3-5].Therefore,the effect of drug therapy alone,especially for heart failure patients with low left ventricular ejection fraction?LVEF?is not ideal.This part of patients repeatedly hospitalized,the quality of life and prognosis are poor,and the annual mortality rate is as high as 30-40%[6-8].There are few reports about the clinical and imaging characteristics of coronary heart disease?CHD?patients with severe reduction of LVEF.Revascularization has short-term or long-term clinical benefits for heart failure caused by of coronary heart disease with reduced left ventricular ejection fraction,but most of the relevant research data come from the results of surgical coronary artery bypass grafting?CABG?.Whether the application of Percutaneous coronary intervention?PCI?in this field is safe and effective is still lack of studies due to the great risks in theory.In this study,we analyzed the clinical and coronary imaging characteristics of patients with heart failure caused by coronary heart disease?CHD?whose LVEF was severely decreased.We also evaluated the efficacy and safety of PCI in the medium term,and explored the characteristics and prevention strategies of HF patients whose LVEF severely decreased.Method:Selected from September 2013 to May 2018 due to acute heart failure with reduction of left ventricular ejection fraction?LVEF?35%?,staying in the 967 Hospital of the People's Liberation Army Joint Service Support Force?formerly the 210th Hospital of the Chinese People's Liberation Army?,with complete data.There were 48 patients,27males and 21 females,with an average age of 71±6.Basic clinical data were collected and divided into 2 groups according to whether or not they received coronary intervention.Test group?PCI treatment group,n=37?underwent coronary angiography?SCA?on the basis of conventional drug therapy,and PCI was treated on coronary anatomical lesions based on the consent of patients and their families.Control group?drug group,n=11?is the conventional drug treatment group.The clinical basic data of the two groups and the characteristics of coronary angiography in the PCI group were analyzed.The changes in cardiac function,brain natriuretic peptide?NT-proBNP?,left ventricular ejection fraction?LVEF?,and left ventricular end-diastolic?LVDd?were compared between the two groups before and after discharge.Happening.The hospitalization time of the two groups and the severity of heart failure and hospitalization within 6 months after hospitalization and discharge were compared,and the recorded data were statistically analyzed.result:1.Basic clinical features:Of the 48 patients,41 had a history of clear myocardial infarction,accounting for 85.4%?41/48?.3 patients had no clear history of myocardial infarction,but electrocardiogram or ultrasonography showed with old myocardial infarction,accounting for 6.25%?3/48?.Of the patients with a history of myocardial infarction,only 13 patients received timely revascularizations,accounting for 29.5%?13/44?of patients with a history of myocardial infarction.Of the 37 patients in test group,33 patients had a clear history of myocardial infarction,accounting for 89.2%?33/37?.2 patients had no clear history of myocardial infarction,but ECG or ultrasound showed with old myocardial infarction,accounting for 5.4.%?2/37?.Of the patients with a history of myocardial infarction,only 10 patients received timely revascularizations,accounting for 28.6%?10/35?of patients with myocardial infarction.Of the 11 patients in control group,8 patients had a clear history of myocardial infarction,accounting for 72.7%?8/11?.Only 1 patients had no clear history of myocardial infarction,but electrocardiogram or ultrasonography showed with old myocardial infarction,accounting for 9.1%?1/11?.Among the 9 patients,only 3 patients received timely revascularizations,accounting for only 33.3%?3/9?of patients with a history of myocardial infarction.NYHA cardiac function class IV,NP-proBNP,LVEF,and LVDd There was no statistically significant difference in baseline levels.2.Characteristics of coronary angiography:?1?There are 30 patients with severe stenosis of 2 or more vessels?stenosis?70%normal reference vessel diameter degree?,accounting for 81.1%.?2?One or two vessels with chronic obstructive disease?CTO?:11 CTO lesions involved 1 vessel,accounting for 29.7%?11/37?;6 CTO lesions involved 2 vessels,accounting for 16.2%?6/37?2 cases of CTO lesions involving 3vessels,accounting for 5.4%?2/37?.Among them,anterior descending vascular involvement was the most,accounting for 37.8%?14/37?,followed by right coronary artery 21.6%?8/37?,and gyro branch accounting for 18.9%?7/37?.11 patients underwent complete revascularization and 26 patients underwent incomplete revascularization.3.Comparison of cardiac function before discharge between the two groups:In test group,NYHA heart function improved by 2 grades in 4 cases,accounting for 10.8%?4/37?;increased 1 grade in 10 cases,accounting for 27.0%?10/37?;no changes in 23cases,accouting for 62.2%?23/37?;In control group,NYHA heart function improved by1 grades in 5 cases,accounting for 45.5%?5/11?;6 cases were unchanged,accounting for 54.5%?6/11?,and there was no one had improved 2 grades.4.Comparison of the results from the two groups of tests:?1?NT-proBNP:the difference was statistically significant before getting out of hospital,one month and six months?1501.5±121.9 vs.1990.0±69.0,P<0.05?,?1218.7±124.7 vs 1854.9±113.8,P<0.05?,?1036.7±137.6 vs.1509.1±116.7,P<0.05?.?2?creatinine value:There was a statistically significant difference between the control group and the treatment group before getting out of hospital?67.4±4.1 vs.59.9±3.0,P<0.05?.?3?LVEF:The difference between the two groups was statistically significant at 6 months?35.0±2.3 vs.31.9±0.8,P<0.05?.?4?LVDd:The difference between the two groups was statistically significant at 6 months?57.0±5.0 vs.61.1±1.7,P<0.05?.5.Comparison of hospitalization time between the two groups:The duration in hospital between test group and control group had significant difference.6.Differences in LVEF?35.0±2.3 vs31.9±0.8,P=0.000<0.05?and LVDd?56.9±5.0vs61.1±1.7,P=0.010<0.05?between the two groups during the 6-month observation period after discharge was statistically significant.Comparison of MACE events within6 months:2 patients in test group were re-admitted due to acute heart failure,and 4 patients in control group were re-admitted.Patients in the two groups re-attending to hospital due to acute heart failure?5.4%vs36.4%,P=0.027<0.05?was statistically different.There were no deaths in both of the 2 groups.Conclusion:1.Most of the heart failure patients with reduced left ventricular ejection fraction caused by coronary heart disease have a history of myocardial infarction,and have not received the revascularization therapy timely and effectively.It is still important to improve the timely and effective reperfusion therapy in acute phase of myocardial infarction.2.Patients with coronary heart disease with HFrEF have severe coronary lesions, mostly with 2 or more lesions.CTO lesions are common and are most susceptible in left anterior descending?LAD?.3.Compared with conservative treatment of drugs,PCI can:?1?in the hospital:reduce NT-proBNP value,shorten hospitalization time,;?2?out of hospital:During 6 months,increase LVEF value,shorten LVDd value,reduce heart failure readmission rate.4.There was no difference in mortality between the two groups during the 6-month follow-up period,which may be related to short follow-up.PCI treatment is safe,based on conventional drug treatment can improve the quality of life and prognosis of patients. |
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