Risk Factors And Clinical Characteristics In Patients With Coronary Heart Disease Complicated With Chronic Heart Failure

Objectives:To investigate the risk factors and clinical characteristics in patients with coronary heart disease(CHD)complicated with chronic heart failure.Methods:Using the retrospective analysis method,the patients' medical record information from June 1,2018 to June 30,2019 were consulted through the electronic medical record system of The First Affiliated Hospital of Zhengzhou University,finally 236 patients were included,who hospitalized at cardiovascular department for the first time,and were diagnosed as coronary heart disease,which was confirmed by coronary angiography.They were divided into heart failure group or normal cardiac function group according to cardiac function.And differences in sex,age,smoking history,comorbidities,biochemical indicators,ECG indicators,echocardiography indicators and coronary lesions were compared between the two groups.Risk factors of patients in the heart failure group were analyzed by Logistic regression analysis.Patients with coronary heart disease complicated with chronic heart failure were divided into three groups:heart failure with preserved ejection fraction,mid-range ejection or reduced ejection,and the differences of clinical characteristics among the three groups were compared.The data analysis was carried out using SPSS 22.0.Results:1.The results of comparison between the heart failure group and the normal cardiac function group showed that:(1).General data:Atrial fibrillation accounted for 1.72%,10.83%respectively in the normal cardiac function group and the heart failure group,and the difference was statistically significant.And in sex,age,smoking history,high blood pressure and diabetes mellitus there was no statistically significant difference.(2).Clinical data:the levels of serum creatinine,serum uric acid,cTnT and NT-proBNP were higher in the heart failure group and the differences were statistically significant.The differences of hemoglobin,total cholesterol,low density lipoprotein and serum potassium were not statistically significant.There was no statistically significant difference in QRS duration.The fQRS complex accounted for 24.14%,45%respectively in the normal cardiac function group and the heart failure group,and the difference was statistically significant.Patients in the heart group had larger left ventricular end diastolic diameter and left atrial diameter and lower left ventricular ejection fraction,and the differences were statistically significant.(3).Coronary angiography:single-vessel lesions were dominant in the normal cardiac function group,while the proportion of multi-vessel lesions were higher in the heart failure group while there was no statistically significant difference.The SYNTAX score was higher in the heart failure group with statistically significant difference.(4).Univariable Logistic regression analysis showed that atrial fibrillation,serum uric acid,serum creatinine,NT-proBNP,left ventricular end diastolic diameter,left atrial diameter,SYNTAX score and fQRS complex were risk factors for coronary heart disease with chronic heart failure,and multivariable Logistic regression analysis showed that NT-proBNP?left ventricular end diastolic diameter and left atrial diameter were independent risk factors for coronary heart disease with chronic heart failure.(5).Spearman correlation analysis results showed that fQRS complex was positively correlated with NT-proBNP,left ventricular end diastolic diameter,left atrial diameter and SYNTAX score,but negatively correlated with left ventricular ejection fraction.2.Clinical characteristics of patients with coronary heart disease complicated with chronic heart failure with different left ventricular ejection fraction:there were 120 patients with coronary heart disease complicated with chronic heart failure,including 63 patients with HFpEF,42 patients with HEmrEF,15 patients with HFrEF.The age of patients in HFrEF group was higher than patients in HFmrEF group,and the difference was statistically significant.The level of NT-proBNP in patients with HFpEF was lower than that in patients with HFmrEF and HErEF,and the difference was statistically significant.The cTnT and serum uric acid in patients with HFpEF were lower than that in patients with HFrEF,and the differences were statistically significant.The fQRS complex in patients with HFpEF,HFmrEF,or HFrEF accounted for 19.05%,78.57 and 60%,respectively,it was significantly lower in patients with HFpEF than that in patients with HFmrEF or HFrEF,and the difference was statistically significant.Compared with patients with HFpEF or HFmrEF,the left atrium diameter in patients with HFrEF was larger,and the difference was statistically significant.As the left ventricular ejection fraction decreased,the left ventricular diastolic diameter gradually increased,and the difference among the three groups was statistically significant.Conclusions:1.Left ventricular diastolic diameter and left atrial diameter may be independent risk factors for patients with coronary heart disease complicated with chronic heart failure.2.fQRS has certain reference value for evaluating cardiac function and cardiac remodeling in patients with coronary heart disease.3.Patients with coronary heart disease complicated with chronic heart failure have different clinical characteristics,which need to be explored from multiple aspects.