Echocardiographic Features Of Heart Failure With Preserved Ejection Fraction Combined With Atrial Fibrillation

Objective:To study the changes of cardiac structure and function in heart failure with preserved ejection fraction(HFpEF)combined with atrial fibrillation(AF).Methods:According to the presence or absence of AF,349 cases of HFpEF patients were divided into the HFpEF+AF group(128 cases)and the HFpEF group(221 cases),and 102 healthy patients were selected as the normal control group,we compared the differences of cardiac structural and functional indexes among the three groups.In addition,128 patients in the HFpEF+AF group were used as the research object to observe the differences of cardiac structural and functional indexes in different types of AF(paroxysmal and persistent).Results:(1)in HFpEF+AF group,NT-proBNP,right ventricular structural indexes(RV-D1?RV-D2?RVOT1?RA-D1?RA-D2 and RAA),left ventricular structural and functional indexes(LAD?LADi?LAV?LAVi?LVIDs?E/A and E/FPV)were all greater than HFpEF group and normal control group,while left ventricular functional indexes(FS?LVEF?DT?IVRT and S/D)were smaller than HFpEF group and normal control group(P<0.01).The left and right ventricular structural indexes(RV-D3?RVOT2?IVSTd?IVSTs?PWTd?PWTs?LVIDd?LVM-Al and LVMi-AL)of HFpEF+AF group and HFpEF group were all higher than normal control group(P<0.01).Multiple regression analysis showed that there was no significant correlation between left atrial structure and left ventricular function in HFpEF+AF group.(2)Compared with HFpEF combined with paroxysmal atrial fibrillation group,NT-proBNP?right heart structural indexes(RV-D1?RV-D2?RA-D1?RA-D2?RAA)?left heart structural and functional indexes(LAD?LADi?LAV?LAVi?FPV)were increased in the HFpEF combined with persistent atrial fibrillation group,and left ventricular functional indexes(FS?IVRT?S's?S/D)were decreaseed in the HFpEF combined with persistent atrial fibrillation group(P<0.05).(3)two variables Logistic regression analysis showed that decreased systolic blood pressure(OR=0.967,P=0.000)was the protective factor for HFpEF combined with AF,increased diastolic blood pressure(OR=1.050,P=0.001)and heart rate(OR=1.027,P=0.003)were the risk factors for HFpEF combined with AF,and increased body mass index(OR=1.193,P=0.030)was the risk factors for HFpEF combined with persistent atrial fibrillation.Conclusion:(1)Compared with patients without AF,The patient of HFpEF combined with AF had more obvious enlargement in left atrium,right atrium and right ventricle,while left ventricular diastolic dysfunction was not obvious,which may be related to the complex mechanisms.(2)In patients of HFpEF combined with persistent atrial fibrillation,structural changes in left atrium,right atrium,and right ventricle were more pronounced,and left ventricular diastolic function should be carefully assessed.(3)Decreased systolic blood pressure was a protective factor for HFpEF combined with AF,increased diastolic blood pressure and heart rate were risk factors for HFpEF combined with AF,and increased body mass index was a risk factor for HFpEF combined with persistent atrial fibrillation.