Clinical Characteristics And Outcomes Of Elderly Patients With Heart Failure With The Mid-range Of Ejection Fraction

Background:In 2016,the new category of heart failure(HF),HF with mid-range left ventricular ejection fraction(LVEF)(HFmrEF),has recently been proposed by Europe Society of Cardiology(ESC).However,the clinical features and pathophysiology of HFmrEF can be very different.The clinical features of HFmrEF remain to be fully examined.Objective:To study the clinical charactertics,related risk factors and outcomes of elderly HFmrEF patients.Methods:We continuously collected data from January 2013 to January 2017 from heart failure patients.These patients were hospitalized in the First Affiliated Hospital of Soochow University.370 patients were stratified into 3 groups based on their left ventricular ejection fraction value after admission:HFmrEF group(LVEF between 40%to 49%),HFrEF group(LVEF<40%)and HFpEF group(LVEF>50%).There were 112 patients in HFmrEF group,97 patients in HFrEF group and 161 patients in HFpEF group.Their demographic information,HF causes,clinical characteristics,cardiac ultrasonographic data,laboratory testing data and therapies were recorded.After the patients leaving hostipal,we also followed up with the 3 groups of patients via phone to get their endpoints.The endpoints of the study was major cardiovascular events.Results:There were 112 patients in the HFmrEF group,accounting for 30.3%of the sample size,which was between HFrEF group(26.2%)and HFpEF group(43.5%).The age and systolic blood pressure level of HFmrEF group were between HFrEF and HFpEF.The the male proportion was significantly higher than that of HFpEF group(P<0.05).The number of patients with smoking history,NYHA III/IV grade,length of hospital stay,hypertension,cerebral infarction,dilated cardiomyopathy and atrial fibrillation in HFmrEF group was between HFrEF group and HFpEF group.The history of coronary heart disease in the HFmrEF group was significantly higher than that in the HFrEF group and the HFpEF group(P<0.05).The levels of blood sodium,high density lipoprotein,apolipoprotein A1,lymphocyte ratio,NT-proBNP,alanine aminotransferase,total bilirubin,direct bilirubin,urea,uric acid,phosphorus,neutrophil ratio,Plasma D-dimer in HFmrEF patients were between the HFrEF group and the HFpEF group(P<0.05).The proportion of eccentric hypertrophy and centripetal remodeling/hypertrophy was similar in the HFmrEF group(40.2%vs.40.2%).From HFrEF to HFmrEF to HFpEF,the left ventricular end-systolic,end-diastolic diameter and left ventricular mass index gradually decreased,the left ventricular posterior wall thickness,septal thickness and relative wall thickness gradually increased(P<0.05).The application rate of angiotensin ?receptor blockers,calcium channel blocker,diuretic,digoxin and spironolactone in HFmrEF group was between HFrEF group and HFpEF group(P<0.05).The application rate of warfarin in HFmrEF group was significantly lower than that in HFpEF group(P<0.05).The application rates of angiotensin converting enzyme inhibitor and aspirin in HFmrEF group was significantly higher than that in HFpEF group(P<0.05).The application rates of nitrates and clopidogrel in HFmrEF group were significantly higher than those in HFrEF group and HFpEF group(P<0.05).Compared with HFrEF group,body mass index and left ventricular end-diastolic diameter were important risk factors for HFmrEF patients.Compared with HFpEF group,smoking history and left ventricular end systolic diameter were important risk factors for HFmrEF patients.The incidence of MCE events in HFmrEF group was between HFrEF group and HFpEF group,which was better than HFrEF group and worse than HFpEF group.The serum creatinine,triglyceride and low total protein were related to the poor prognosis of HFmrEF patients.Male,serum potassium and C-reactive protein were related to the poor prognosis of HFrEF patients.Age,glutamic oxalate transaminase and NYHA grade were related to the poor prognosis of HFpEF patientsConclusion:HFmrEF patients,who accounted for 30.3%of elderly patients with chronic heart failure,was an important part of the HF patients.The main cause of HFmrEF was coronary heart disease.There were more males in HFmrEF group.The clinical characteristics,degree of heart failure cardiac structure and clinical medication of HFmrEF group were between HFrEF group and HFpEF group.Obesity and smoking were important risk factors in patients with HFmrEF.The prognosis of HFmrEF was better than HFrEF,but worse than HFpEF.When HFmrEF patients had high serum creatinine,triglycerides and low total protein,they would have poor prognosis.