Relations between heart failure with normal ejection fraction and cardiac remodeling / 中国综合临床

ABSTRACT

Objective To investigate the relationship between heart failure with normal ejection fraction and cardiac remodeling.Methods One hundred and eighty-eight cases with chronic heart failure were collected from January 2009 to March 2012 from Department of Cardiology of Longkou People's Hospital.In strictly accordance with the diagnostic criteria,participants were divided into HFNEF(n =109) and HFREF groups (n =79).According to the NYHA classification,HFNEF and HFREF patients were further divided into three subgroups respectively (HFNEF patients52 cardiac function Ⅱ,36 cardiac function Ⅲ,21 cardiac function Ⅳ ;HFREF patients13 cardiac function Ⅱ,27 cardiac functionⅢ,39 cardiac functionⅣ).The measurements of the left ventricular ejection fraction (LVEF),left atrial diameter (LAD),interventricular septal thickness (IVST),left ventricular posterior wall thickness (LVPWT),right ventricular diameter (RVD) were conducted in all objects and their clinical data were statistically analyzed.Results Compared with HFREF patients,HFNEF group had older mean age ((64.59 ± 5.34) yrs vs.(58.89 ± 4.23) yrs,t =3.345,P =0.001),more female patients (58.7％ (64/109) vs.41.8％ (33/79),x2 =5.265,P =0.022),higher incidence of hypertension (81.65％ (89/109) vs.63.29％ (50/79),x2 =8.012,P =0.005).LVPWT,IVST,LAD,RVD gradually increased in HFNEF patients with the severity of cardiac function,with significant differences in LVPWT ((9.05 ± 1.89) mm vs.(11.30 ± 2.67) mm vs.(13.90 ± 2.77) mm,F =3.578,P =0.028),IVST ((9.35 ±1.75)mm vs.(11.51 ±2.48)mm vs.(12.98 ±3.01)mm,F =3.081,P =0.048),LAD ((31.23 ±5.98)mm vs.(35.55 ±7.31)mm vs.(44.81 ± 10.72)mm,F =6.711,P ＜0.001),but no difference in RVD ((18.95 ±1.02) mm vs.(19.21 ± 1.11) mm vs.(19.99 ± 0.98) mm,F =2.751,P ＞ 0.05).There was significant difference in LVPWT ((13.90 ±2.77)mm vs.(7.45 ±2.01)mm,t =11.439,P ＜0.001),IVST ((12.98 ±3.01)mm vs.(7.23 ± 1.94)mm,t =10.318,P ＜0.001),RVD ((19.99 ±0.98)mm vs.(23.51 ± 1.10)mm,t =2.838,P ＜ 0.001) between HFNEF and HFREF patients with Ⅳ level of cardiac function,while there was no statistical difference ((44.81 ± 10.72) nn vs.(46.30 ± 11.76) mm),t =1.451,P =0.151) on LAD.Conclusion Senior age,high proportions of women and essential hypertension are found in HFNEF patients.Impaired cardiac function has increasing impact on cardiac remodeling with the increase of severity but it almost has no effect on the right ventricle.Ventricular structural changes exist significantly different from HFNEF to HFREF.Therefore clinicians should have in-depth understanding of the characteristics of the HFNEF and its epidemiology,pathophysiology,diagnostic criteria and treatment principles in order to improve diagnosis and treatment of this class of patients.