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首页> 外文期刊>Polish Archives of Internal Medicine >Incidence of chronic heart failure with preserved left ventricular ejection fraction in patients with hypertension and isolated mild diastolic dysfunction
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Incidence of chronic heart failure with preserved left ventricular ejection fraction in patients with hypertension and isolated mild diastolic dysfunction

机译：高血压和单纯轻度舒张功能不全患者慢性心力衰竭伴左心室射血分数保留的发生率

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INTRODUCTION Heart failure (HF) with preserved ejection fraction (HFPEF) is still a challenge in clinical practice. The prognosis of patients with HFPEF is similar to or only slightly better than that of patients with HF with reduced ejection fraction (HFREF). Impaired relaxation is the mildest form of diastolic dysfunction, which should not be accompanied by symptoms of HFPEF. OBJECTIVES The aim of the study was to assess the incidence of chronic HFPEF in patients with hypertension and isolated mild diastolic dysfunction. PATIENTS AND METHODS It was a cross-sectional study including 210 patients (mean age, 56.11 ±6.24 years; women, 58%) with isolated abnormalities of left ventricular relaxation and arterial hypertension. In addition, we identified patients with type 2 diabetes to compare the incidence of HFPEF between patients with and without diabetes. HFPEF was diagnosed when clinical symptoms of HF were present simultaneously with echocardiographic markers of elevated left ventricular diastolic pressure, pulmonary congestion on chest X-ray, or elevated serum brain natriuretic peptide (BNP) levels. RESULTS HFPEF was diagnosed in 42% of the patients with impaired relaxation. An elevated left atrial volume index (>34 ml/m2) was observed in 38% of the patients; E/e’ ratio exceeding 8, in 37%; elevated BNP levels, in 39%; and pulmonary congestion on chest X-ray, in 41%. Independent predictors of HFPEF were age, systolic blood pressure of 140 mmHg or higher, type 2 diabetes, coronary artery disease, and an estimated glomerular filtration rate of less than 60 ml/min/1.73 m2. In diabetic patients, a positive correlation was found between an insulin dose (>80 units/day) and BNP levels. CONCLUSIONS Patients with isolated relaxation abnormalities constitute a clinically heterogeneous group because some of these individuals present with symptoms of HFPEF and a simultaneous increase in BNP levels. Therefore, the question of whether diastolic dysfunction is mild should be readdressed, and it should be emphasized that these patients have a serious prognosis with the risk of HF. In diabetic patients, a positive correlation between high insulin doses and BNP levels requires further research.
机译：简介保留射血分数（HFPEF）的心力衰竭（HF）在临床实践中仍然是一个挑战。 HFPEF患者的预后与射血分数降低（HFREF）的HF患者相似或仅略好于HF患者。放松受损是舒张功能障碍最轻微的形式，不应伴有HFPEF症状。目的本研究的目的是评估高血压和单纯轻度舒张功能障碍患者中慢性HFPEF的发生率。患者与方法这是一项横断面研究，包括210例左心室舒张和动脉高压异常的患者（平均年龄56.11±6.24岁;女性58％）。此外，我们确定了2型糖尿病患者，以比较有无糖尿病患者HFPEF的发生率。当HF的临床症状与左心室舒张压升高，胸部X线片上的肺充血或血清脑钠肽（BNP）水平升高同时伴有超声心动图标志同时出现时，诊断为HFPEF。结果42％的放松障碍患者被诊断出HFPEF。在38％的患者中观察到左心房容积指数升高（> 34 ml / m2）。电子比例超过8，达37％; BNP水平升高，为39％;胸部X光检查显示肺部充血和肺部充血，占41％。 HFPEF的独立预测因素是年龄，收缩压为140 mmHg或更高，2型糖尿病，冠状动脉疾病以及估计的肾小球滤过率低于60 ml / min / 1.73 m2。在糖尿病患者中，发现胰岛素剂量（> 80单位/天）与BNP水平呈正相关。结论具有孤立性松弛异常的患者构成临床异质性组，因为其中一些个体出现HFPEF症状并同时BNP水平升高。因此，舒张功能障碍是否为轻度的问题应予以解决，并应强调这些患者预后严重，有心衰风险。在糖尿病患者中，高胰岛素剂量和BNP水平之间的正相关性需要进一步研究。

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