Clinical Characteristics,prognosis And The Efficacy Of ARNI Of Hospitalized HFmrEF Patients

Objective:To investigate the clinical characteristics,outcomes and cardiac hyperthyroidism of ARNI intervention of the Heart Failure of Mid-range Ejection Fraction(HFmrEF)through a prospective cohort study.Method:Our registered clinical trial(DRAGEN-HF,NCT:03727828)had successively enrolled 570 completely recorded heart failure patients from July 2017 to July 2018 and followed their major end-points(all-cause death,cardiac death,and heart failure re-hospitalization).All subjects were divided into 3 groups according to the left ventricular ejection fraction(LVEF):patients with LVEF<40%assigned to HFrEF group,patients with LVEF?40%and<50%assigned to HFmrEF group,and patients with LVEF>50%assigned to HFpEF group.Baseline characteristic,history,etiology,lab detection,echocardiographic parameters,in-patient treatment,outcome events,and left ventricular systolic function after 6-8 months of ARNI intervention were compared in 3 groups.Result:Our trial has enrolled 570 heart failure patients(male accounts for 63%,n=361),losing 35 cases(6%)after a mean follow-up period of 13±3.65 months.There were 62 all-cause deaths.Respect of clinical characteristics:the age and proportion of dilated cardiomyopathy in the HFmrEF group were between the HFpEF group and the HFrEF group(P<0.0167).Compared with the HFrEF group,the HFmrEF group had a larger proportion of women,hypertension and NYHA ?(P<0.0167),and a smaller proportion of coronary heart disease,valvular heart disease,NYHA ? and NYHA ?(P<0.0167).Compared with the HFpEF group,the HFmrEF group had a smaller proportion of atrial fibrillation,smoking and drinking(P<0.0167),and a larger proportion of ischemic cardiomyopathy(P<0.005).Biochemical examination:the concentration of NT-pro-BNP in the HFmrEF group was between the HFpEF group and the HFrEF group(P<0.005).Troponin T was highest in the HFmrEF group(P<0.005).Compared with the HFrEF group,the serum uric acid concentration of HFmrEF group was lower(P<0.005).Compared with the HFpEF group,the concentration levels of hemoglobin,CRP,indirect bilirubin,glutamate transaminase and glutamate transaminase in the HFmrEF group were higher(P<0.05).Thyroid hormone levels were lower(P<0.005).Echocardiogram:the end-diastolic left ventricular diameter and end-systolic left ventricular diameter of the HFmrEF group were between the HFpEF group and the HFrEF group(P<0.001),and the tricuspid regurgitation pressure was the lowest.Compared with the HFrEF group,the HFmrEF group had higher interventricular septum thickness and left ventricular posterior wall thickness(P<0.005)and lower left atrial diameter(P<0.001).In terms of drug treatment in admission,compared with the HFrEF group,the utilization rate of diuretics and spironolone in the HFmrEF group was low(P<0.001),the utilization rate of statins was high(P<0.0167),the utilization rate of shakubatol valsartan was high(P<0.001),and the utilization rate of nitrate was low(P<0.0167).Compared with the three groups of patients before and after the treatment,the results showed that the EF of patients with HFrEF and HFmrEF improved significantly(P<0.05),while the EF of patients with HFpEF did not improve significantly(P>0.05).In terms of prognosis,there was no significant difference in mortality among the three groups(P>0.05).Conclusion:1.HFmrEF coronary heart disease,ischemic cardiomyopathy as the main cause.2.The characteristics of the population were similar to that of HFpEF,but the clinical characteristics were closer to that of HFrEF,and drug therapy was similar to that of HFrEF.3.Salbutamol Valsartan could significantly improve LVEF in patients with HFrEF and HFmrEF,but not in the HFpEF patients.4.Overall,the HFmrEF features were between the two,but the 1-year prognosis was not significantly different from that of HFrEF,HFpEF.