射血分数中间型心力衰竭患者的临床特征及心脏结构功能变化

苟春丽; 刘永铭; 薛丽丽; 马苏美; 杨京港; 杨琳; 杜颖石

doi:10.13201/j.issn.1001-1439.2021.06.010

射血分数中间型心力衰竭患者的临床特征及心脏结构功能变化

- 1. 兰州大学第一医院老年心血管科甘肃省老年疾病临床医学研究中心(兰州,730000);
- 2. 兰州大学第一医院超声诊断科
基金项目:
甘肃省卫健委卫生行业科研计划项目(No:GSWSKY-2019-08)

详细信息

通讯作者: 刘永铭,E-mail:cardtonm@263.net

中图分类号: R541.6

收稿日期: 2020-10-20

修回日期: 2021-03-08

Clinical characteristics and changes of cardiac structure and function in heart failure with mid-range ejection fraction

- 1. Department of Geriatric Cardiology,Gansu Provincial Clinical Research Center for Geriatric Medicine,the First Hospital of Lanzhou University;
- 2. Department of Ultrasonic Diagnosis,the First Hospital of Lanzhou University, Lanzhou, 730000, China

More Information

Corresponding author: LIU Yongming, E-mail: cardtonm@263.net

Received Date: 20 October 2020

Revised Date: 08 March 2021

摘要

摘要: 目的:分析射血分数中间型心力衰竭(HFmrEF)患者的临床特征及心脏结构功能的变化情况。方法:从新诊断的935例心力衰竭(心衰)患者中选择年龄、性别、心功能分级匹配的HFmrEF、射血分数减低心衰(HFrEF)、射血分数保留心衰(HFpEF)各100例,另选择年龄、性别相匹配的健康人100例作为对照。分析心衰患者心脏结构功能改变的特点。结果:HFmrEF组年龄、心功能Ⅲ~Ⅳ级比例、气促、咳嗽、运动耐量下降以及肝脾肿大的发生率、氨基末端B型利钠肽前体(NT-proBNP)水平介于HFpEF组和HFrEF组之间。HFmrEF组左心室、左心房容积及其指数以及左心室质量指数与HFpEF组更接近,左心室舒张功能与HFpEF组相比无统计学差异,收缩功能强于HFrEF组而弱于HFpEF组,左心室充盈压高于HFpEF组而与HFrEF组无显著性差异。HFmrEF组肺动脉高压患病率与HFrEF组无统计学差异,但高于HFpEF组(P=0.017)。HFmrEF组右心不同结构指标异常率为11.0%~46.0%,右心室长轴内径、主动脉瓣上右心室流出道内径小于HFrEF组,右心室壁厚度大于HFrEF组,但均与HFpEF组无显著性差异。结论:HFmrEF是大部分临床特征和心脏结构功能变化介于HFrEF和HFpEF之间的心衰亚型。
- 心力衰竭 /
- 临床特点 /
- 心脏结构与功能
Abstract: Objective: To investigate clinical characteristics and changes of cardiac structure and function in heart failure with mid-range ejection fraction(HFmrEF).Methods: From newly diagnosed 935 patients with heart failure, 100 cases with HFmrEF, 100 cases with preserved ejection fraction(HFpEF), and 100 cases with reduced ejection fraction(HFrEF) were selected. All patients were matched by age, gender, and cardiac function, and 100 healthy volunteers matched in age and gender were served as controls. Echocardiography was used to study cardiac structural and functional changes.Results: Age and the prevalence of NYHAⅢ-Ⅳ, shortness of breath, cough, impaired exercise tolerance, hepatosplenomegaly, and the level of NT-proBNP in the HFmEF group were intermediate between HFpEF and HFrEF groups. The volume and index of left ventricular and left atrial, and left ventricular mass index in the HFmrEF group were closer to those in the HFPEF group. The left ventricular diastolic function in the HFmrEF group was not significantly different from that in the HFpEF group. Still, the systolic function was better than that in the HFrEF group and poorer than that in the HFpEF group. The left ventricular filling pressure was heavier than that in the HFpEF group and close to the HFrEF group. The prevalence of pulmonary hypertension in the HFmrEF group was not different from that in the HFrEF group but higher than that in the HFpEF(P=0.017). The abnormal rate of various structural parameters of the right heart in the HFmrEF group was 11.0% to 46.0%. The right ventricular longitudinal dimension and right ventricular outflow tract above the aortic valve in the HFmrEF group were smaller than those in the HFrEF group. The ventricular free wall thickness in the HFmrEF group was greater than that in the HFrEF group. Still, there was no significant difference regarding to all the right cardiac structural parameters above between HFmrEF and HFpEF group.Conclusion: HFmrEF is a subtype of heart failure with clinical characteristics and cardiac structure and function that fall in an intermediate position between HFrEF and HFpEF.
- heart failure /
- clinical characteristics /
- cardiac structure and function

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参考文献(12)

[1]	汪朝晖,廖玉华.浅谈以左室射血分数分类心衰的局限性[J].临床心血管病杂志,2020,36(2):105-106.
[2]	Rastogi A,Novak E,Platts AE,et al.Epidemiology,pathophysiology and clinical outcomes for heart failure patients with a mid-range ejection fraction[J].Eur J Heart Fail,2017,19(12):1597-1605.
[3]	Lauritsen J,Gustafsson F,Abdulla J.Characteristics and long-term prognosis of patients with heart failure and mid-range ejection fraction compared with reduced and preserved ejection fraction:a systematic review and meta-analysis[J].ESC Heart Fail,2018,5(4):685-694.
[4]	Fonarow GC,Stough WG,Abraham WT,et al.Characteristics,treatments,and outcomes of patients with preserved systolic function hospitalized for heart failure:a report from the OPTIMIZE-HF Registry[J].J Am Coll Cardiol,2007,50(8):768-777.
[5]	Sweitzer NK,Lopatin M,Yancy CW,et al.Comparison of clinical features and outcomes of patients hospitalized with heart failure and normal ejection fraction(>or=55%)versus those with mildly reduced(40% to 55%)and moderately to severely reduced(<40%)fractions[J].Am J Cardiol,2008,101(8):1151-1156.
[6]	Cheng RK,Cox M,Neely ML,et al.Outcomes in patients with heart failure with preserved,borderline,and reduced ejection fraction in the Medicare population[J].Am Heart J,2014,168(5):721-730.
[7]	Lund LH,Claggett B,Liu J,et al.Heart failure with mid-range ejection fraction in CHARM:characteristics,outcomes and effect of candesartan across the entire ejection fraction spectrum[J].Eur J Heart Fail,2018,20(8):1230-1239.
[8]	He KL,Burkhoff D,Leng WX,et al.Comparison of ventricular structure and function in Chinese patients with heart failure and ejection fractions>55% versus 40% to 55% versus<40%[J].Am J Cardiol,2009,103(6):845-851.
[9]	Lyu S,Yu L,Tan H,et al.Clinical characteristics and prognosis of heart failure with mid-range ejection fraction:insights from a multi-centre registry study in China[J].BMC Cardiovasc Disord,2019,19(1):209.
[10]	Dumitrescu D,Gerhardt F,Viethen T,et al.70-year-old woman with cardiac hypertrophy and severe pulmonary hypertension:pre-or postcapillary?[J].Dtsch Med Wochenschr,2011,136(50):2594-2598.
[11]	司金萍,李骁,刘莹.射血分数改善型心力衰竭的研究进展[J].临床心血管病杂志,2020,36(3):296-300.
[12]	Hsu JJ,Ziaeian B,Fonarow GC.Heart failure with mid-range(borderline)ejection fraction:clinical implications and future directions[J].JACC Heart Fail,2017,5(11):763-771.