老年女性射血分数保留心力衰竭住院患者的临床特点
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摘要
目的分析老年女性射血分数保留心力衰竭(HFpEF)住院患者的临床特点。方法回顾性调查2016年4月1日～2017年3月31日福建医科大学附属协和医院首次住院的年龄≥65岁的女性心力衰竭患者168例,按LVEF分为HFpEF组(LVEF≥40%)136例和射血分数降低心力衰竭(HFrEF)组(LVEF<40%)32例。结果HFpEF组年龄、体质量指数(BMI)、收缩压,心房颤动、贫血均高于HFrEF组[(76.44±7.28)岁vs (72.47±8.19)岁、(25.11±3.34)kg/m~2 vs (22.95±3.53)kg/m~2、(140.49±20.77)mm Hg vs (131.09±19.96)mm Hg(1mm Hg=0.133kPa)、44.1%vs 25.0%和22.1%vs 6.3%,P<0.05,P<0.01],HFpEF组主要病因为高血压(85.3%)。HFpEF组肌酐、尿酸、血钾、N末端B型钠尿肽前体、心率、QT间期、QRS间期、室性心律失常、左心室舒张末期内径、左心室收缩末期内径、左心房内径、肺动脉内径均明显低于HFrEF组;血钠、室间隔厚度明显高于HFrEF组(P<0.05,P<0.01)。HFpEF组使用钙离子通道阻滞剂比例明显高于HFrEF组;血管紧张素转换酶抑制剂类/血管紧张素Ⅱ受体拮抗剂、利尿剂、β受体阻滞剂、洋地黄、调脂药物比例明显低于HFrEF组(P<0.05,P<0.01)。结论老年女性HFpEF住院患者的年龄较大、BMI较高,高血压、心房颤动、贫血等共病较多见。
Objective To analyze the clinical characteristics of hospitalized elderly female heart failure(HF)patients with preserved ejection fraction.Methods One hundred and sixty-eight≥65 years old hospitalized female HF patients admitted to our hospital from 2016-04-01 to 2017-03-31 were divided into elderly HF with preserved ejection fraction(HFpEF)group(n=136)with their LVEF≥40%and HF with reduced ejection fraction(HFrEF)group(n=32)with their LVEF<40%).Their clinical characteristics were retrospectively analyzed.Results The age was significantly older,the BMI,SBP and incidence of AF and anemia were significantly higher in HFpEF group than in HFrEF group(76.44±7.28 year vs 72.47±8.19 years,25.11±3.34 kg/m~2 vs 22.95±3.53 kg/m~2,140.49±20.77 mm Hg vs 131.09±19.96 mm Hg,44.1% vs 25.0%,22.1% vs6.3%,P<0.05,P<0.01).The main cause of HF was hypertension(85.3%)in HFpEF group.The serum creatinine,UA,potassium,NT-proBNP levels were significantly lower,the heart rate was significantly slower,the QT and QRS intervals were significantly shorter,the incidence of ventricular arrhythmia was significantly lower,the LVEDD,LVESD,LA and pulmonary artery diameter were significantly shorter while the serum sodium level was significantly higher and the interventricular septum was significantly thicker in HFpEF group than in HFrEF group(P<0.05,P<0.01).The ratio of CCB therapy was significantly higher while the ratios of angiotension converting enzyme inhibitor/angiotension Ⅱreceptor antagonist therapy,diuretics therapy,beta-blockers therapy,digitalis therapy and lipid-lowering drug therapy were significantly lower in HFpEF group than in HFrEF group(P<0.05,P<0.01).Conclusion The age is older,the BMI and incidence of hypertension,AF and anemia are higher in hospitalized elderly HF female patients with preserved ejection fraction.
Objective To analyze the clinical characteristics of hospitalized elderly female heart failure(HF)patients with preserved ejection fraction.Methods One hundred and sixty-eight≥65 years old hospitalized female HF patients admitted to our hospital from 2016-04-01 to 2017-03-31 were divided into elderly HF with preserved ejection fraction(HFpEF)group(n=136)with their LVEF≥40%and HF with reduced ejection fraction(HFrEF)group(n=32)with their LVEF<40%).Their clinical characteristics were retrospectively analyzed.Results The age was significantly older,the BMI,SBP and incidence of AF and anemia were significantly higher in HFpEF group than in HFrEF group(76.44±7.28 year vs 72.47±8.19 years,25.11±3.34 kg/m~2 vs 22.95±3.53 kg/m~2,140.49±20.77 mm Hg vs 131.09±19.96 mm Hg,44.1% vs 25.0%,22.1% vs6.3%,P<0.05,P<0.01).The main cause of HF was hypertension(85.3%)in HFpEF group.The serum creatinine,UA,potassium,NT-proBNP levels were significantly lower,the heart rate was significantly slower,the QT and QRS intervals were significantly shorter,the incidence of ventricular arrhythmia was significantly lower,the LVEDD,LVESD,LA and pulmonary artery diameter were significantly shorter while the serum sodium level was significantly higher and the interventricular septum was significantly thicker in HFpEF group than in HFrEF group(P<0.05,P<0.01).The ratio of CCB therapy was significantly higher while the ratios of angiotension converting enzyme inhibitor/angiotension Ⅱreceptor antagonist therapy,diuretics therapy,beta-blockers therapy,digitalis therapy and lipid-lowering drug therapy were significantly lower in HFpEF group than in HFrEF group(P<0.05,P<0.01).Conclusion The age is older,the BMI and incidence of hypertension,AF and anemia are higher in hospitalized elderly HF female patients with preserved ejection fraction.
引文
[1]Kessler EL,Rivaud MR,Vos MA,et al.Sex-specific influence on cardiac structural remodeling and therapy in cardiovascular disease[J].Biol Sex Differ,2019,10(1):7-18.DOI:10.1186/s13293-019-0223-0.
[2]Beale AL,Meyer P,Marwick TH,et al.Sex differences in cardiovascular pathophysiology:why women are overrepresented in heart failure with preserved ejection fraction[J].Circulation,2018,138(2):198-205.DOI:10.1161/CIRCULA-TIONAHA.118.034271.
[3]齐海梅.重视老年女性心血管疾病[J].中华老年心脑血管病杂志,2017,19(10):1009-1011.DOI:10.3969/j.issn.1009-0126.2017.10.001.
[4]Ponikowski P,Voors AA,Anker SD,et al.2016ESC guidelines for the diagnosis and treatment of acute and chronic heart failure:the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology(ESC).Developed with the special contribution of the Heart Failure Association(HFA)of the ESC[J].Eur JHeart Fail,2016,189(8):891-975.DOI:10.1002/ejhf.592.
[5]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.中国心力衰竭诊断和治疗指南2014[J].中华心血管病杂志,2014,42(2):98-122.DOI:10.3760/cma.j.issn.0253-3758.2014.02.004.
[6]Duca F,Zotter-Tufaro C,Kammerlander AA,et al.Genderrelated differences in heart failure with preserved ejection fraction[J].Sci Rep,2018,8(1):1080-1088.DOI:10.1038/s41598-018-19507-7.
[7]Ganapathi S.Heart failure with preserved ejection fraction in the elderly:challenges and management[J].Geriatric Medicine,2018,17(7):263-272.DOI:10.1007/978-981-10-3253-0_17.
[8]Xanthopoulos A,Triposkiadis F,Starling RC.Heart failure with preserved ejection fraction:classification based upon phenotype is essential for diagnosis and treatment[J].Trends Cardiovasc Med,2018,28(6):392-400.DOI:10.1016/j.tcm.2018.01.001.
[9]Tibrewala A,Yancy CW.Heart failure with preserved ejection fraction in women[J].Heart Fail Clin,2019,15(1):9-18.DOI:10.1016/j.hfc.2018.08.002.
[10]Upadhya B,Kitzman DW.Heart failure with preserved ejection fraction in older adultst[J].Heart Fail Clin,2017,13(3):485-502.DOI:10.1016/j.hfc.2017.02.005.
[11]Issa O,Peguero JG,Podesta C,et al.Left atrial size and heart failure hospitalization in patients with diastolic dysfunction and preserved ejection fraction[J].J Cardiovasc Echogr,2017,27(1):1-6.DOI:10.4103/2211-4122.199064.
[12]Lam CS,Rienstra M,Tay WT,et al.Atrial fibrillation in heart failure with preserved ejection fraction:association with exercise capacity,left ventricular filling pressures,natriuretic peptides,and left atrial volume[J].JACC Heart Fail,2017,5(2):92-98.DOI:10.1016/j.jchf.2016.10.005.
[13]Beale AL,Nanayakkara S,Segan L,et al.Sex differences in heart failure with preserved ejection fraction pathophysiology:a detailed invasive hemodynamic and echocardiographic analysis[J].JACC Heart Fail,2019,7(3):239-249.DOI:10.1016/j.jchf.2019.01.004.
[14]Singh T,Nagesh S,Ray TK.Magnitude and correlates of anemia in elderly women of a resettlement colony of delhi[J].JMidlife Health,2018,9(1):21-25.DOI:10.4103/jmh.JMH_57_17.
[15]Mantovani A,Targher G,Temporelli PL,et al.Prognostic impact of elevated serum uric acid levels on long-term outcomes in patients with chronic heart failure:apost-hoc analysis of the GISSI-HF(Gruppo Italiano per lo Studio della Sopravvivenza nella Insufficienza Cardiaca-Heart Failure)trial[J].Metabolism,2018,83:205-215.DOI:10.1016/j.metabol.2018.02.007.
[16]Huang A,Qi X,Hou W,et al.Prognostic value of sST2and NT-proBNP at admission in heart failure with preserved,mid-ranged and reduced ejection fraction[J].Acta Cardiol,2017,73(1):41-48.DOI:10.1080/00015385.2017.1325617.
[17]Berthelot E,Montani D,Algalarrondo V,et al.A clinical and echocardiographic score to identify pulmonary hypertension due to HFpEF[J].J Card Fail,2017,23(1):29-35.DOI:10.1016/j.cardfail.2016.10.002.
[18]李健,刘婷,苗立夫,等.扩张型心肌病继发肺动脉高压与功能性二尖瓣反流的相关性临床研究[J].中国心血管病研究,2018,16(7):613-617.DOI:10.3969/j.issn.1672-5301.2018.07.010.
[19]Juillière Y,Suty-Selton C,Riant E,et al.Prescription of cardiovascular drugs in the French ODIN cohort of heart failure patients according to age and type of chronic heart failure[J].Arch Cardiovasc Dis,2014,107(1):21-32.DOI:10.1016/j.acvd.2013.11.001.
[20]Cleland JGF,Bunting KV,Flather MD,et al.Beta-blockers for heart failure with reduced,mid-range,and preserved ejection fraction:an individual patient-level analysis of doubleblind randomized trials[J].Eur Heart J,2018,39(1):26-35.DOI:10.1093/eurheartj/ehx564.
[21]Kontogeorgos S,Thunstr ME,Johansson MC,et al.Heart failure with preserved ejection fraction has a better longterm prognosis than heart failure with reduced ejection fraction in old patients in a 5-year follow-up retrospective study[J].Int J Cardiol,2017,232(1):86-92.DOI:10.1016/j.ijcard.2017.01.048.
[2]Beale AL,Meyer P,Marwick TH,et al.Sex differences in cardiovascular pathophysiology:why women are overrepresented in heart failure with preserved ejection fraction[J].Circulation,2018,138(2):198-205.DOI:10.1161/CIRCULA-TIONAHA.118.034271.
[3]齐海梅.重视老年女性心血管疾病[J].中华老年心脑血管病杂志,2017,19(10):1009-1011.DOI:10.3969/j.issn.1009-0126.2017.10.001.
[4]Ponikowski P,Voors AA,Anker SD,et al.2016ESC guidelines for the diagnosis and treatment of acute and chronic heart failure:the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology(ESC).Developed with the special contribution of the Heart Failure Association(HFA)of the ESC[J].Eur JHeart Fail,2016,189(8):891-975.DOI:10.1002/ejhf.592.
[5]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.中国心力衰竭诊断和治疗指南2014[J].中华心血管病杂志,2014,42(2):98-122.DOI:10.3760/cma.j.issn.0253-3758.2014.02.004.
[6]Duca F,Zotter-Tufaro C,Kammerlander AA,et al.Genderrelated differences in heart failure with preserved ejection fraction[J].Sci Rep,2018,8(1):1080-1088.DOI:10.1038/s41598-018-19507-7.
[7]Ganapathi S.Heart failure with preserved ejection fraction in the elderly:challenges and management[J].Geriatric Medicine,2018,17(7):263-272.DOI:10.1007/978-981-10-3253-0_17.
[8]Xanthopoulos A,Triposkiadis F,Starling RC.Heart failure with preserved ejection fraction:classification based upon phenotype is essential for diagnosis and treatment[J].Trends Cardiovasc Med,2018,28(6):392-400.DOI:10.1016/j.tcm.2018.01.001.
[9]Tibrewala A,Yancy CW.Heart failure with preserved ejection fraction in women[J].Heart Fail Clin,2019,15(1):9-18.DOI:10.1016/j.hfc.2018.08.002.
[10]Upadhya B,Kitzman DW.Heart failure with preserved ejection fraction in older adultst[J].Heart Fail Clin,2017,13(3):485-502.DOI:10.1016/j.hfc.2017.02.005.
[11]Issa O,Peguero JG,Podesta C,et al.Left atrial size and heart failure hospitalization in patients with diastolic dysfunction and preserved ejection fraction[J].J Cardiovasc Echogr,2017,27(1):1-6.DOI:10.4103/2211-4122.199064.
[12]Lam CS,Rienstra M,Tay WT,et al.Atrial fibrillation in heart failure with preserved ejection fraction:association with exercise capacity,left ventricular filling pressures,natriuretic peptides,and left atrial volume[J].JACC Heart Fail,2017,5(2):92-98.DOI:10.1016/j.jchf.2016.10.005.
[13]Beale AL,Nanayakkara S,Segan L,et al.Sex differences in heart failure with preserved ejection fraction pathophysiology:a detailed invasive hemodynamic and echocardiographic analysis[J].JACC Heart Fail,2019,7(3):239-249.DOI:10.1016/j.jchf.2019.01.004.
[14]Singh T,Nagesh S,Ray TK.Magnitude and correlates of anemia in elderly women of a resettlement colony of delhi[J].JMidlife Health,2018,9(1):21-25.DOI:10.4103/jmh.JMH_57_17.
[15]Mantovani A,Targher G,Temporelli PL,et al.Prognostic impact of elevated serum uric acid levels on long-term outcomes in patients with chronic heart failure:apost-hoc analysis of the GISSI-HF(Gruppo Italiano per lo Studio della Sopravvivenza nella Insufficienza Cardiaca-Heart Failure)trial[J].Metabolism,2018,83:205-215.DOI:10.1016/j.metabol.2018.02.007.
[16]Huang A,Qi X,Hou W,et al.Prognostic value of sST2and NT-proBNP at admission in heart failure with preserved,mid-ranged and reduced ejection fraction[J].Acta Cardiol,2017,73(1):41-48.DOI:10.1080/00015385.2017.1325617.
[17]Berthelot E,Montani D,Algalarrondo V,et al.A clinical and echocardiographic score to identify pulmonary hypertension due to HFpEF[J].J Card Fail,2017,23(1):29-35.DOI:10.1016/j.cardfail.2016.10.002.
[18]李健,刘婷,苗立夫,等.扩张型心肌病继发肺动脉高压与功能性二尖瓣反流的相关性临床研究[J].中国心血管病研究,2018,16(7):613-617.DOI:10.3969/j.issn.1672-5301.2018.07.010.
[19]Juillière Y,Suty-Selton C,Riant E,et al.Prescription of cardiovascular drugs in the French ODIN cohort of heart failure patients according to age and type of chronic heart failure[J].Arch Cardiovasc Dis,2014,107(1):21-32.DOI:10.1016/j.acvd.2013.11.001.
[20]Cleland JGF,Bunting KV,Flather MD,et al.Beta-blockers for heart failure with reduced,mid-range,and preserved ejection fraction:an individual patient-level analysis of doubleblind randomized trials[J].Eur Heart J,2018,39(1):26-35.DOI:10.1093/eurheartj/ehx564.
[21]Kontogeorgos S,Thunstr ME,Johansson MC,et al.Heart failure with preserved ejection fraction has a better longterm prognosis than heart failure with reduced ejection fraction in old patients in a 5-year follow-up retrospective study[J].Int J Cardiol,2017,232(1):86-92.DOI:10.1016/j.ijcard.2017.01.048.