Clinical Characteristics And Prognosis Of Patients With Ischemic Cardiomyopathy Combined With Heart Failure With Improved Ejection Fraction

Objective:To analyze the clinical characteristics and prognosis of patients with ICM complicated with HFimp EF.Methods:Patients with ischemic cardiomyopathy(ICM)who were admitted to the heart center of Hebei General Hospital from June 2018 to May 2021 were selected.Among these patients,patients with heart failure(HF)were selected.For patients,consult the electronic medical records to obtain the baseline clinical data of the patients.Patients were divided into four types according to the left ventricular ejection fraction(LVEF)obtained during admission and reexamination,namely,heart failure with improved ejection fraction(HFimp EF),heart failure with preserved ejection fraction,and heart failure with preserved ejection fraction(HFp EF),heart failure with mid-range ejection fraction(HFmr EF),heart failure with reduced ejection fraction(HFr EF).The included patients were divided into improved ejection fraction group,preserved ejection fraction group,median ejection fraction group,and reduced ejection fraction group according to the above HF classification.The start time of the follow-up was set as the time of the last echocardiogram review.Follow-up was conducted by consulting the inpatient medical record system,outpatient follow-up records,and telephone calls.All-cause death and all-cause readmission were taken as the end points of this study.The 1-year followup of patients in each group was recorded,and the Kaplan-Meier survival curve of 1-year follow-up was drawn,and the risk factors of all-cause death and all-cause readmission were analyzed by Cox proportional hazards model.Results:A total of 425 patients were included in this study,including95 cases in the HFimp EF group,68 cases in the HFp EF group,84 cases in the HFmr EF group,and 178 cases in the HFr EF group.All-cause mortality in the HFimp EF group was lower than that in the HFr EF group(P<0.001).Patients with HFimp EF had a lower cumulative readmission rate than patients with HFmr EF(P=0.004).Combined atrial fibrillation [HR=3.849,95% CI(1.050,14.108),P=0.042],anemia [HR=4.957,95% CI(1.282,19.171),P=0.020],were risk factors for death in patients with ICM combined with HFimp EF.Elevated BMI,LVEDD>55mm,non-use of SGLT2 i were independent risk factors for all-cause readmission in patients with ICM combined with HFimp EF(P<0.05).Conclusion:Among ICM patients,patients with improved ejection fraction are a special HF population.These patients are younger,have a lower degree of ventricular remodeling,and have a higher proportion of drugs guided by guidelines such as ARNI and MRA,and have a better prognosis.AF and anemia were independent risk factors for all-cause death in ICM patients with HFimp EF.Higher BMI,no use of SGLT2 i,and LVEDD>55 mm were independent risk factors for all-cause readmission in ICM patients with HFimp EF.