ABSTRACT
Objective:To investigate the clinical characteristics and the risk of major adverse cardiac events within 1 year of middle-aged and elderly in-patients with acute decompensated and mid-range ejection fraction heart failure(HF)in the medical alliance setting.Methods:A retrospective cohort study was conducted among a total of 180 in-patients with acute decompensated heart failure in Cardiovascular Hexi Hospital Consulting Area of Tianjin Chest Hospital.According to ejection fraction measured by echocardiogram, the in-patients were classified into three groups: heart failure with reduced ejection fraction(HFrEF)group(n=70, 38.9%), HFmEF group(n=50, 27.8%), and heart failure with preserved ejection fraction(HFpEF)group(n=60, 33.3%). Clinical feature and 1-year prognosis between different groups were compared.Results:Univariate Cox regression analysis of 1-year all-cause death and cardiovascular death showed that there was no significant difference between HFrEF group and HFmEF group, HFpEF group and HFmEF group(all P>0.05); 1-year readmission analysis of heart failure showed that 47.1%(33 cases)of HFrEF group was higher than 24.0%(12 cases)of HFmEF group, 48.3%(29 cases)of HFpEF group was higher than HFmEF group( HR=2.307, 2.368, 95% CI: 0.187-4.480, 1.207-4.644, respectively, all P<0.05); The major 1-year cardiovascular events were 57.1%(40 cases)higher in the HFrEF group than 34.0%(17 cases)in the HFmEF group( HR=2.053, 95% CI: 0.187-4.408, P< 0.05). Multivariate analysis showed that the 1-year risk of major cardiovascular events was significantly different between HFmEF group and HFpEF group( HR=0.477, 95% CI: 0.241-0.941, P< 0.05). Pulmonary heart disease( P< 0.05), atrial flutter and/or atrial fibrillation( P< 0.01), New York Cardiology class Ⅳ( P< 0.01)were risk factors for death.Hypertension and cor pulmonale were the risk factors for readmission in patients with heart failure(all P< 0.01). Conclusions:The clinical characteristics of inpatients with HFmEF in the medical alliance setting tended to be consistent with those with HFrEF, while the feature of ischemic heart disease was more prominent in HFmEF.The 1-year risk of heart failure readmission in HFmEF group was significantly lower than that in HFpEF and HFrEF group, and the risk of all-cause mortality and cardiovascular mortality at 1 year was not significantly different among the three groups.
ABSTRACT
Objective To explore the change in plasma B-type natriuretic peptide (BNP) concentration and its potential influencing factors in elderly patients with hypertension.Methods A total of 137 patients with hypertension [75 males,62 females,aged (78.3±7.5) years] were enrolled in this study.Patients were divided into 3 groups:simple hypertension (SH) group (n=36),hypertension combined with cardiac structural changes (HCSC) group (n=31),and hypertension combined with systolic heart failure (HHF) group (n=70).Plasma BNP concentration was measured by immunofluorescence antibody method.Cardiac structure and function parameters in patients were detected by echocardiography within 24-48 hours after taking blood samples.Data was analyzed by SPSS 16.0.Results There were significant differences in the value of lgBNP among HHF,HCSC and SH groups (2.8±0.4,2.0±0.5,1.9±0.5,respectively,F 61.69,P＜0.05).Multiplelinear regression analysis showed that left atrial diameter (LAD),left ventricular ejection fraction (LVEF),age,LVMI (left ventricular mass index) and pulse pressure (PP) were the five effective variables of the lgBNP (F=58.69,P＜0.05) in HCSD group and SH group.The regression equation was:lgBNP=0.010X1 +0.007X2-0.054X3 +0.049X1 +0.013X5 +2.635 (X1 represented as PP,X2 as age,X3 as LVEF,X4 as LAD and X5 as LVMI).The standardized regression coefficient of X1 to X5 was0.446,0.235,-0.621,0.574 and 0.457,respectively.The value of lgBNP in patients with normal contractile function was higher in patients with late diastolic mitral flow velocity ratio (E/A)＜1 than in those with E/A＞1 (2.42±0.35 vs.2.25±0.16,t=0.94,P＜0.05).Conclusions The plasma BNP concentration is negatively correlated with LVEF and positively correlated with LAD,PP,age and LVMI in elderly patients with hypertension.The effect degree from great to little in line was LVEF,LAD,LVMI,PP and age.In addition,there is a negative correlation between plasma BNP concentration and E/A ratio in patients with normal contractile function.