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| Cardiac structure and function in elderly heart failure patients with preserved ejection fraction complicated with anemia |
| Received:June 28, 2022 |
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| DOI：10.11915/j.issn.1671-5403.2023.01.004 |
| Key words:aged heart failure with preserved ejection fraction anemia cardiac structural remodeling left ventricular diastolic functionThis work was supported by the 2020 Public Service Platform Project of National Ministry of Industry and Information Technology |
| Author Name | Affiliation | | ZHU Jian | Department of Cardiology, Second Medical Center, Chinese PLA General Hospital, Beijing 100853, China
National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing 100853, China
Beijing Key Laboratory of Chronic Heart Failure Precision Medicine, Beijing 100853, China | | BIAN Su-Yan | Department of Cardiology, Second Medical Center, Chinese PLA General Hospital, Beijing 100853, China
National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing 100853, China
Beijing Key Laboratory of Chronic Heart Failure Precision Medicine, Beijing 100853, China | | LIU Shan-Shan | Department of Cardiology, Second Medical Center, Chinese PLA General Hospital, Beijing 100853, China
National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing 100853, China
Beijing Key Laboratory of Chronic Heart Failure Precision Medicine, Beijing 100853, China | | WANG Bin-Hua | Disaster Medical Research Center, | | XU Hong-Li | Big Data Research Center, Medical Innovation Research Division, Chinese PLA General Hospital, Beijing 100853, China | | HE Kun-Lun | Big Data Research Center, Medical Innovation Research Division, Chinese PLA General Hospital, Beijing 100853, China |
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| Abstract: |
| Objective To analyze the characteristics of cardiac structure and function in elderly heart failure patients with preserved ejection fraction (HFpEF) complicated with anemia. Methods A total of 2281 elderly HFpEF patients ≥60 years old hospitalized in the First Medical Center of Chinese PLA General Hospital from February 2008 to December 2019 were enrolled and divided into anemia group (n=949) and control group (n=1332) according to whether they were accompanied by anemia. The clinical characteristics, cardiac ultrasonic structure and function were analyzed and compared between the 2 groups. The data were analyzed with EmpowerStats statistical software (version 3.0) and R software. According to the data type, independent sample t-test, Kruskal Wallis H test or Chi-square test was used for comparison between groups. Multivariate linear regression model was employed to analyze the influencing factors of hemoglobin (HGB) and the correlation of HGB with cardiac ultrasound indexes. Results The prevalence of anemia was 41.6% (949/2 281) in the elderly HFpEF inpatients. The patients of the anemia group had significantly higher ratio of males [54.69% (519/949) vs 47.75% (636/1332)], older age [(74.79±7.99) vs (73.40±7.72 years], higher systolic blood pressure [(140.06±23.80) vs (136.77±23.05) mmHg (1mmHg=0.133kPa)], increased hospital all-cause mortality [3.58% (34/949) vs 1.50% (20/1 332)], and higher levels of fasting blood glucose [(7.68±3.35) vs (7.02±3.38) mmol/L], N-terminal pro B-type natriuretic peptide [NT-proBNP, 3118.01 (1137.21,8 976.32) vs 1 333.34 (596.32,2 777.11) ng/L] and troponin T [0.04 (0.02,0.08) vs 0.02 (0.01,0.04) μg/L], but lower body mass index [(24.34±4.10) vs (24.87±4.05) kg/m2], HGB level [(9.37±1.65] vs [13.32±1.45) g/dl] and estimated glomerular filtration rate [38.85 (13.98,73.98) vs 76.26 (57.79,95.87) ml/(min · 1.73m2)]when compared with the patients in the control group (all P<0.05). There were statistical differences between the 2 groups in heart function classification and chronic kidney disease (CKD) stage (both P<0.05). Cardiac ultrasound results showed that compared with the control group, the left heart in the anemia group expanded more significantly, with larger left atrial anteroposterior diameter [(41.43±8.13) vs (40.64±7.62 mm], left atrial volume index [29.82(22.55,38.80) vs 28.38(20.55,38.96) ml/m2], left ventricular end systolic diameter [(32.63±4.48) vs (31.64±4.89) mm], left ventricular end diastolic diameter [(46.87±5.78) vs (45.75±6.47) mm], left ventricular end systolic volume [(44.98±23.97) vs (41.15±15.75) ml] and left ventricular end diastolic volume [(103.69±30.07) vs (97.36±31.03) ml]; more significant left ventricular hypertrophy was observed, with increased left ventricular mass index [(120.24±39.99) vs (110.14±36.91) g/m2]and left ventricular posterior wall thickness [(10.68±1.47) vs (10.47±1.52) mm]; the right heart load was aggravated, with widened diameter of the right ventricle [(36.74±7.12) vs (35.90±7.42) mm], diameter of the main pulmonary artery [(22.93±3.40) vs (22.51±3.63) mm] and diameter of the inferior vena cava [(16.89±4.18) vs (16.15±3.93) mm] (all P<0.05). Multiple linear regression analysis indicated that C-reactive protein, NT-proBNP and CKD ≥4 were independent risk factors for lower HGB. Low HGB was an independent risk factor for left ventricular end systolic volume, left ventricular end diastolic volume, left ventricular end systolic diameter, left ventricular end diastolic diameter, left ventricular mass index and left atrial volume index. Conclusion Elderly HFpEF inpatients have a high prevalence of anemia, and cardiac structural remodeling and diastolic dysfunction were more evident in anemic patients. Inflammation and poor cardiac and renal function are independent risk factors for anemia, while anemia is closely related to cardiac structure and functional remodeling. |
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