Clinical Characteristics And Prognosis Of Patients With Chronic Heart Failure With Different Pathogeny

Objective:1.To analyze the clinical characteristics of patients with chronic heart failure caused by different pathogenies,and to provide evidence for the prevention and treatment of chronic heart failure;2.To analyze the factors influencing the prognosis of chronic heart failure and provide guidance for improving the prognosis.Subjects and methods:1.From February 2017 to February 2018,262 CHF patients hospitalized in the First Affiliated Hospital of Nanhua University and enrolled in China-PEACE5 were selected.According to the etiology,they were divided into 126 CHD(coronary heart disease)patients,21 hypertensive heart disease patients,61 dilated cardiomyopathy patients and 54 valvular heart disease patients.The patient's medical history(including the first symptoms of heart failure,the time of first standard diagnosis and treatment intervention,complications),baseline information(including gender,height,weight,age,smoking and drinking);2.All the patients in the First Affiliated Hospital of Nanhua University received intravenous blood samples immediately after admission.The plasma NT-proBNP level was measured by ELISA,blood routine was detected by automated blood analyzer,and LVEF was measured by color Doppler echocardiography in B-ultrasound department of the First Affiliated Hospital of Nanhua University when the condition was stable;3.All enrolled patients were interviewed or telephoned in January,June and December to record the patient's clinical endpoint(readmission events of heart failure and cardiovascular death events);4.To analyze the clinical characteristics of different etiological groups,Logistic regression analysis was used to analyze the causes,complications of heart failure,Make Kaplan-Meier survival curve for the survival time of each cause,and determine the influence of the cause and related complications on the prognosis.Result: 1.Among the 262 patients with chronic heart failure,126(48.1%)with coronary heart disease,61(23.3%)with dilated heart disease,54(20.6%)with valvular heart disease and 21 with high heart disease(8%);There were significant differences in age,gender,height,weight and smoking among patients with different etiology.There was no significant difference in drinking: the age of coronary heart disease group was the largest(69.99±9.62 years)and the dilated cardiomyopathy group was the smallest(56.92±12.89 years old).The dilated cardiomyopathy group was the highest(165.02±7.19m),the lowest was in the valvular disease group(160.80±7.77m);the weight in the hypertensive heart disease group was the heaviest(65.86±12.80kg)and the lowest was in the valvular heart disease group(54.41±9.62kg);Male morbidity is common and smoking in the dilated cardiomyopathy group is rare;LSD-t test compares height,age and weight in pairs.The chi-square test compares smoking,drinking and gender,age,gender,height,weight and smoking;there were statistical differences between the above groups;It showed that age,sex,height,weight and smoking were related to the etiology of chronic heart failure,while alcohol consumption was not related to the etiology.2.The etiologies of chronic heart failure at different ages are different: the age of 20 years old is mainly due to the dilated cardiomyopathy,valvular disease and coronary heart disease begin to appear at the age of 30.The age of onset of the dilated cardiomyopathy is younger than the other three diseases;the onset age of heart failure with different causes was(62.75 +12.13)years old,mainly between 50 and 75 years old,the first diagnosis age of heart failure with different etiologies was(64.89±12.03)years old,mainly between 50 and 75 years old;there was no significant difference in the age at first diagnosis and the age atonset age among different etiologies of heart failure;3.The incidence of complications in patients with heart failure : hypertension vs arrhythmia vs diabetes vs chronic renal insufficiency(CKD)vs hyperlipidemia vs anemia(45.8% vs 26.3% vs 15.3% vs 2.7% vs 1.9%vs 35.5%);4.There were significant differences in LVEF value,6-minute walking test and treatment plan among the etiologies,among which LVEF value was the lowest(32.61(+9.49%)in patients with dilated heart disease,the highest(49.90(+15.21%)in patients with valvular heart disease,the shortest 6-minute walking distance in patients with coronary heart disease(the median is 300m),and the longest 6-minute walking distance in patients with hypertensive heart disease(the median is 433m).The patients with coronary heart disease received the most comprehensive treatment.NT-ProBNP had no significant difference among groups;5.The incidence of adverse events was 20.2%(53 cases),including 5 cardiovascular deaths(1.9%)and 48 re-hospitalizations(18.3%);there was no significant difference in the prognostic factors.Patients with chronic renal insufficiency(CKD)and anemia had higher re-admission rate and cardiovascular mortality.Conclusion: 1.Coronary heart disease group was the most common cause of chronic heart failure,the age of onset was the oldest and exercise tolerance was the worst in patients with coronary heart disease,most of them were males,and most of them were accompanied by smoking;The age of onset of CHF was the youngest and the LVEF value was the worst in the dilated Cardiomyopathy group;The incidence of chronic heart failure was the lowest in the high heart disease group,and exercise tolerance was the best;Female patients with valvular heart disease of chronic heart failure are more common;the overall age of heart failure is younger.2.The prognosis of patients with chronic renal insufficiency(CKD)and anemia is worse.