老年人心力衰竭伴射血分数正常的临床特征和预后。
Clinical characteristics and prognosis of heart failure with normal left ventricular ejection fraction in elderly patients.
机构信息
Department of Cardiology, Beijing Hospital, the Ministry of Health of China, Beijing 100730, China.
出版信息
Chin Med J (Engl). 2012 Aug;125(16):2853-7.
BACKGROUND
The term heart failure with normal ejection fraction (HFNEF) is often used to describe the syndrome of heart failure with normal ejection fraction. Based on the previous studies, HFNEF has a significant morbidity and mortality and is associated with a similar prognosis to heart failure with reduced ejection fraction (HFREF). The present study aimed to investigate the clinical characteristics and prognosis of HFNEF in elderly patients.
METHODS
Consecutive elderly patients (≥ 60 years old) hospitalized for the first episode of heart failure (HF) in Beijing Hospital from January 2003 to December 2009 were retrospectively recruited. Three hundred and ten patients with HF were eligible for our study. As recently recommended, a cut-off value of 50% was used to distinguish HFNEF (LVEF ≥ 50%) from HFREF (LVEF < 50%). Data were retrospectively obtained from hospital records and databases. Follow-up data were obtained by telephone and from hospital records. For every eligible patient, the clinical characteristics and prognosis were collected and compared between the HFNEF and HFREF groups.
RESULTS
Patients with HFNEF accounted for 54.5% of all cases of elderly patients with HF. Compared with HFREF, the elderly patients with HFNEF had a higher proportion of females (62.1% vs. 32.6%, P < 0.001), higher body mass index (BMI) ((24.9 ± 4.7) vs. (23.5 ± 4.0) kg/m(2), P = 0.011), higher systolic blood pressure at admission ((141.5 ± 22.6) vs. (134.3 ± 18.6) mmHg, P = 0.002), but lower hemoglobin levels ((118.3 ± 22.7) vs. (125.8 ± 23.8) g/L, P = 0.005). The incidence of coronary heart disease (43.2% vs. 65.2%, P < 0.001) and myocardial infarction (16.6% vs. 46.1%, P < 0.001) were significantly lower in elderly patients with HFNEF than in those with HFREF (P < 0.001). With a mean follow-up of 33.5 (0.5 - 93) months, 120 patients (38.7%) died, including 94 (30.3%) cardiac deaths. The HFNEF group had fewer deaths than the HFREF group at the end of the first follow-up (46/169 (27.2%) vs. 58/141 (41.1%)) and at the end of the second follow-up (56/169 (33.1%) vs. 64/141 (45.4%)). Kaplan-Meier survival analysis showed a significantly higher survival rate in elderly patients with HFNEF than those with HFREF (P = 0.021 for total mortality and P < 0.001 for cardiac mortality). Multiple Logistic regression analysis showed that LVEF < 50% was an independent risk factor for death in elderly patients with HF.
CONCLUSIONS
More than half of elderly patients with HF have a normal LVEF. The prognosis of the elderly patients with HFNEF is poor, though slightly better than the elderly patients with HFREF.
背景
射血分数保留的心力衰竭（HFNEF）这一术语通常用于描述射血分数正常的心力衰竭综合征。根据以往的研究，HFNEF 具有显著的发病率和死亡率，并与射血分数降低的心力衰竭（HFREF）具有相似的预后。本研究旨在探讨老年患者 HFNEF 的临床特征和预后。
方法
回顾性招募 2003 年 1 月至 2009 年 12 月在北京医院因首次心力衰竭（HF）住院的连续老年患者（≥60 岁）。共有 310 例 HF 患者符合我们的研究标准。最近建议使用 50%的截断值来区分 HFNEF（LVEF≥50%）和 HFREF（LVEF<50%）。从医院记录和数据库中回顾性获取数据。通过电话和医院记录获取随访数据。对于每一位合格的患者，收集和比较 HFNEF 和 HFREF 组的临床特征和预后。
结果
HFNEF 占所有老年 HF 患者的 54.5%。与 HFREF 相比，HFNEF 的老年患者中女性比例更高（62.1%比 32.6%，P<0.001），体重指数（BMI）更高（（24.9±4.7）比（23.5±4.0）kg/m²，P=0.011），入院时收缩压更高（（141.5±22.6）比（134.3±18.6）mmHg，P=0.002），但血红蛋白水平较低（（118.3±22.7）比（125.8±23.8）g/L，P=0.005）。HFNEF 的老年患者冠心病（43.2%比 65.2%，P<0.001）和心肌梗死（16.6%比 46.1%，P<0.001）的发生率明显低于 HFREF（P<0.001）。平均随访 33.5（0.5-93）个月后，120 例患者（38.7%）死亡，其中 94 例（30.3%）为心源性死亡。HFNEF 组在第一次随访结束时（46/169（27.2%）比 58/141（41.1%））和第二次随访结束时（56/169（33.1%）比 64/141（45.4%））的死亡率均低于 HFREF 组。Kaplan-Meier 生存分析显示，HFNEF 组的老年患者生存率明显高于 HFREF 组（总死亡率 P=0.021，心源性死亡率 P<0.001）。多因素 Logistic 回归分析显示，LVEF<50%是老年 HF 患者死亡的独立危险因素。
结论
一半以上的老年 HF 患者具有正常的 LVEF。HFNEF 老年患者的预后较差，尽管略优于 HFREF 老年患者。
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