Clinical Characteristics And Biomarkers Analysis Of Heart Failure With Preserverd Ejection Fraction

Background:As the end-stage manifestation of various cardiovascular diseases,Heart Failure?HF?has a very high rate of hospitalization and fatality,which is also an important reason affecting the quality of life of patients.2014China heart failure diagnosis and treatment guidelines based on left ventricular ejection fraction?left ventricular ejection fraction,LVEF?,heart failure can be divided heart failure with reduced ejection fraction,HFrEF,EF?<45%?,and heart failure with preserved ejection.HFpEF,EF acuity 45%^[1].At that time,there was a controversy about LVEF standard,and it was believed that LVEF between 41 and 49%could be called critical HFpEF.A new term,heart failure with mid-range ejection fraction?HFmrEF?,was proposed in the 2016 ESC guidelines for patients with 40 to 49%LVEF.The latest guidelines for the diagnosis and treatment of heart failure in China in 2018 adopt the same classification method and divide heart failure into three categories:HFrEF?LVEF<40%?,HFmrEF?LVEF40%⁴9%?,and HFpEF?LVEF>50%?^[2].In this way,the classification of heart failure is more specific and clearer,which also indicates the complexity and refractory nature of heart failure.At present,the relevant studies on HFrEF have been relatively thorough,and the other two types of heart failure are still under discussion.Objective:In this paper,the risk factors of three types of heart failure,cardiac ultrasonography,biomarkers and other aspects were analyzed to explore the clinical characteristics of heart failure with preserved ejection fraction,so as to provide clinical data for HFpEF.Methods:Patients with heart failure admitted to the second department of cardiology in the east hospital of the HeBei medical university from February 2018 to February 2019 were collected.General clinical data and echocardiography and related biochemical findings were recorded in all patients who met the criteria of NYHA cardiac function grading II to IV..According to LVEF,they are divided into three groups:HFrEF?LVEF<40%?group 120 cases,HFmrEF?LVEF40%⁴9%?group 86 cases,HFpEF?LVEF 50%or higher?group 75 examples,the comparison between groups of general clinical data such as gender?sex?,age?age?,BMI?Body Mass Index?Index,type 2 diabetes medical history,history of atrial fibrillation,history of myocardial infarction.And echocardiography of left atrial diameter?LAD?,left the interior diameter?RVD?,e,e/e'value',left ventricular posterior wall thickness?LVPW?to understand differences in heart structure,And biomarkers,including BNP,high sensitivity C-creative protein?hsCRP?,urinary albumin to creatinine ratio,UACR),D Dimer,,etc.Results:1.General clinical data analysis:the proportion of women in the HFpEF group,the history of atrial fibrillation and diabetes was significantly higher than that in the HFrEF group and the HFmrEF group,and the grade of cardiac function was mainly level II,accounting for 54.7%,with statistically significant difference?P<0.05?.The proportion of myocardial infarction in the HFrEF group was significantly higher than that in the other two groups.Grade II and III were the main cardiac function grades,accounting for 75.5%,and the difference was statistically significant?P<0.05?.The age and propor-tion of women in the HFmrEF group were between the other two groups,and the cardiac function grades were mainly II and III,accounting for 76.7%.2.Analysis of cardiac ultrasound indicators:the left atrial diameter and left ventricular diameter of the HFrEF group were greater than those of the HFmrEF group and the HFpEF group,and the HFmrEF group were greater than those of the HFpEF group,with statistically significant differences?P<0.05?.The left ventricular posterior wall thickness of HFpEF group was significantly greater than that of HFrEF and HEmrEF group,and the difference was statistically significant?P<0.05?.The E/E'value of HFpEF group was significantly greater than that of HFmrEF and HFrEF group,and the difference was statistically significant?P<0.05?.3.Biomarker analysis:except d-dimer,BNP,UACR and hsCRP of the three groups were statistically significant?P<0.05?.D-dimer,BNP,UACR and hsCRP were correlated with heart function grading,and the correlation was statistically significant.Among them,the correlation between BNP and UACR and HFpEF was greater than that between BNP and UACR and the other two types of heart failure.Conclusions:1.HFpEF is mostly found in the elderly,most commonly in women and obesity,and is often associated with hypertension,atrial fibrillation and type 2diabetes.HFrEF is mostly found in men and is relatively young,often associated with the history of myocardial infarction.HFmrEF is in between the two in more aspects,with a similar proportion of male and female patients with HFmrEF and a history of myocardial infarction.2.Cardiac structure of HFpEF is dominated by centripetal remodeling,and the type of HFrEF ventricular remodeling presents as eccentric remode-ling.HFmrEF heart structure is more inclined to HFpEF.3.HFpEF was significantly correlated with BNP and UACR,HFmrEF was significantly correlated with BNP,UACR and HsCRP,and HFrEF was significantly correlated with BNP,UACR,HsCRP and d-dime.All of them increased with the increase of cardiac function grading,which could be used as biomarkers for the diagnosis of heart failure and the prediction of cardiovascular events.