左心室射血分数正常的心力衰竭患者临床特点——单中心资料  

Clinical characteristics of heart failure with normal left ventricular ejection fraction

作　　者：罗晓颖[1] 许燕[1] 施仲伟[1] 张凤如[1] 戚文航[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院心脏科,上海200025

出　　处：《诊断学理论与实践》2012年第3期258-262,共5页Journal of Diagnostics Concepts & Practice

摘　　要：目的:分析左心室射血分数正常的心力衰竭(心衰)患者的临床特点。方法:本研究为单中心研究,共入选413例住院的心衰患者和100名年龄、性别、体重匹配且同期超声心动图检查正常的正常对照者,收集病史及体格检查、血液生化检测和经胸超声心动图检查的资料。根据心衰患者的左心室射血分数≥50%或<50%将心衰患者分为射血分数正常心衰组(192例)和射血分数低下心衰组(221例)。随访2组患者心脏事件的发生情况,通过Kaplan-Meier方法进行生存分析。结果:左心室射血分数正常的心衰患者占心衰患者的46.5%。与射血分数低下的心衰患者相比,射血分数正常的心衰患者多为老年女性,其收缩压和脉压明显升高,且多合并心绞痛和糖尿病(P<0.05);心肌存在对称性肥厚,经二尖瓣血流频谱A峰显著降低,E/A比值加大,等容舒张时间(IVRT)显著缩短(P<0.05)。另外,与正常对照者相比,射血分数正常的心衰患者大多合并有贫血和肾功能不全,其血浆N末端B型利钠肽原(NT-proBNP)水平也显著升高(P<0.05)。Kaplan-Meier生存分析显示,2组心衰患者的心脏事件发生率无统计学差异(P=0.36)。结论:射血分数正常的心衰患者的临床特点提示,心内和心外因素可能在射血分数正常的心衰患者病程进展中都起了重要作用。Objective： To analyze the clinical characteristics of heart failure（HF） with normal left ventricular ejection fraction.Methods Four hundred and thirteen patients with HF and 100 age-,sex-and weigh-matched healthy controls were enrolled in this study.All the subjects had history taken and underwent physical examination,blood biochemistry test,and transthoracic echocardiography.The group with HF was further subdivided into HF with normal ejection fraction（EF≥ 50%,n=192）（HFNEF） and HF with low ejection fraction（EF 50%,n=221）（HFLEF）.The two groups were followed to record cardiac events which were defined as death from HF and readmission to hospital for HF.Kaplan-Meier analysis was used to compare event-free survival of the two groups.Results HFNEF accounted for 46.5% of the patients with HF.Compared with HFLEF group,HFNEF group had more patients of elderly female,higher systolic blood pressure and pulse pressure,and more patients with angina pectoris and diabetes（P0.05）,as well as concentric left ventricular hypertrophy and lower late transmitral flow velocity（A）,higher E/A ratio,and greater reduction in isovolumic relaxation time（P0.05）.Compared with the normal control group,more patients in HFNEF group had anemia and renal dysfunction,as well as greater increase in plasma NT-pro BNP level（P0.05）.Kaplan-Meier analysis showed no significant difference in cardiac event between the two HF groups（P=0.36）.Conclusions The clinical characteristics of HF with normal EF in this study suggests that cardiac and extracardiac factors might play important roles in the development and progression of HF.

关 键 词：心力衰竭 射血分数 临床特点 超声心动图 心脏事件 

分 类 号：R541.61[医药卫生—心血管疾病]