| Objectives It is well known that maintenance hemodialysis?MHD?is closely related to heart failure?HF?.MHD with ejection fraction retention heart failure?HFpEF?and MHD with ejection fraction reduction heart failure?HFrEF?have been reported in many literatures.However,there are few studies on MHD complicated with ejection fraction intermediate heart failure?HFmrEF?,so the purpose of this study is to explore the clinical characteristics and related risk factors of MHD patients with HFmrEF.Methods The clinical data of maintenance hemodialysis patients hospitalized in the second Hospital of Tianjin Medical University from June 2017 to December 2018 were analyzed retrospectively.The clinical data of MHD patients were collected and the inclusion variables were determined,including baseline characteristic data,drug use,laboratory examination,color Doppler flow imaging?CDFI?and other related variables.According to the clinical symptoms or signs of heart failure and left ventricular ejection fraction?LVEF?,the patients were divided into four groups: HFrEF group,HFmrEF group,HFpEF group and no heart failure group.Use statistical methods to analyze variables.Results 1.From June 2017 to December 2018,a total of 691 hemodialysis patients were hospitalized in the second Hospital of Tianjin Medical University,after screening,446 patients were included in the study.There were 220?49.3%?,34?7.6%?,42?9.4%?and 150?33.7%?in HFpEF group,HFmrEF group,HFrEF group and NoHF group respectively.The patients with heart failure in HFmrEF group accounted for 11.5% of the total number of patients with heart failure.2.There were 34 patients in the HFmrEF group,including 16 males?47.1%?,with an average age of 58.06±11.74 years?28-70 years?,no significant difference with the other three groups?P>0.05?;mean systolic blood pressure The 154.58±16.31 mmHg,higher than the HFrEF group and the NoHF group,lower than the HFpEF group,the difference between the two groups was statistically significant?P<0.05?;the HFmrEF combination and coronary heart disease patients?58.8%?,the proportion was The highest among the 4 groups was significantly different from the NoHF group?P<0.001?;the HFmrEF combination and atrial fibrillation were 5?14.7%?,which was significantly higher than the NoHF group and between the HFrEF group and the HFpEF group,with the HFrEF group and NoHF.There was no significant difference between the two groups?P<0.05?and the HFpEF group?P>0.05?.There was no significant difference in gender,dialysis years,BMI,primary kidney disease,DBP,hypertension,and diabetes between the four groups?P>0.05?.P>0.05).3.The mean value of NT-pro-BNP in HFmrEF group was 26648±2692 pg/ml,which was lower than that in HFrEF group?P>0.05?,higher than HFpEF group and NoHF group?P<0.05?;HFmrEF group HB The mean value was 83.59±18.91 g ·L -1,which was significantly lower than that of HFpEF group and NoHF group?P<0.05?.There was no significant difference between HFrEF group and HFrEF group?P>0.05?.The average level of UA in HFmrEF group was 455.46±137.97 mmol ·L -1.It was higher than the other 3 groups?P<0.001 for both pairs?;the mean plasma ALB of the HFmrEF group was 35.18±2.90g/L,which was close to the HFpEF group and the NoHF group but not statistically significant?P>0.05?.In the HFrEF group?P<0.05?;there was no significant difference in the other laboratory tests between the 4 groups?P>0.05?.4.There were statistical differences in the use of diuretics,digoxin,antiplatelet drugs,EPO,and iron between the 4 groups.The diuretics used in the HFmrEF group were significantly higher than the other 3 groups?P<0.05 for both groups?;the proportion of patients using antiplatelet drugs in the HFmrEF group was lower than that in the HFrEF group?P<0.05?,higher than the HFpEF group and the NoHF group?P?.<0.05);EPO was higher in HFmrEF group than in HFpEF group and HFrEF group?P<0.05?,similar to NoHF group?P>0.05?;iron in HFmrEF group was significantly higher than HFpEF group and NoHF group?P<0.05?.There was no statistical difference between the HFrEF group and the HFrEF group?P>0.05?.There was no significant difference in the use of ?-blockers,ACEI,ARB,CCB,other antihypertensive drugs,amiodarone and VD.?P>0.05?.5.The left atrial diameter of the HFmrEF group was 44.20±6.62 mm,which was close to the HFrEF group?P>0.05?,higher than the HFpEF group and the NoHF group?P<0.05?.The left ventricular end-diastolic endothelium of the HFmrEF group was 53.96±10.09 mm.,higher than HFpEF group and NoHF group?P<0.05?,lower than HFrEF group?P<0.05?;there was no significant difference in ventricular septal thickness,left ventricular posterior wall thickness and E/A between the 4 groups?P>0.05?.6.Univariate Logistic regression analysis showed that atrial fibrillation,coronary heart disease,SBP,LA,LVEDD,HB,UA were the risk factors for HFmrEF in MHD patients.Multivariate Logistic regression analysis showed that coronary heart disease,SBP,LVEDD,HB,UA were important risk factors for HFmrEF in MHD patients,and the higher SBP,larger LVEDD,lower HB and higher UA,the higher the risk of HFmrEF.Conclusions 1.There were only 34 patients with MHD complicated with HFmrEF,accounting for 7.6% of the total number of patients with HFmrEF,accounting for 11.5% of the total number of patients with heart failure.The average age of MHD patients with HFmrEF was significantly lower than that of HFmrEF patients in the general population,and most of them were female,and 2.in the four groups,the age and sex of HFmrEF patients were close to those of HFpEF patients.The patients with coronary heart disease were close to HFrEF patients;the uric acid level of HFmrEF patients was the highest and the HB level was the lowest;the levels of cardiac color Doppler ultrasound and BNP were between the two.3.Coronary heart disease,SBP,LVEDD,HB,UA are the risk factors of HFmrEF in MHD patients,and the higher the SBP,the larger the LVEDD,the lower the HB and the higher the UA,the higher the risk of HFmrEF. |
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