Relationship among cardiac function, prognosis and levels of blood pressure in elderly patients with acute attack of chronic heart failure

Objective To study the relationship among cardiac function,prognosis and different levels of blood pressure in elderly patients with acute attack of chronic heart failure.Methods A total of 204 elderly patients with acute attack of chronic heart failure were enrolled in this study.According to systolic blood pressure (SBP) level,all the patients were divided into group A (37 cases,SBP ≤100 mmHg,1mmHg =0.133 kPa),group B(73 cases,SBP 101-140 mmHg),group C (56 cases,SBP 141-180 mmHg)and group D (38 cases,SBP ＞ 180 mmHg).The left ventricularcar end-diastolic volume (LVEDV),left ventricular ejection fraction (LVEF),cardiothoracic ratio (C/T),N terminal pro-brain natriuretic peptide (NT-proBNP) and creatinine were measured.According to cardiogenic death or not after 1 year's follow-up,patients were divided into death group (53 cases) and survival group (151 cases),and the indicators were compared.Results The proportion of hypertension in group C and group D was significantly higher than that in group A and group B [82.1％(46/56),89.5％(34/38) vs.35.1％(13/37),37.0％ (27/73)],the proportion of ischemic heart disease and cardiac function in New York heart association (NYHA) class Ⅳ in group C and group D was significantly higher than that in group A [69.6％ (39/56),73.7％ (28/38) vs.29.7％ (11/37); 53.6％(30/56),57.9％(22/38) vs.21.6％(8/37)],and the differences were statistically significant (P ＜0.05).There were significant differences in lgNT-proBNP,C/T,LVEF and LVEDV among the four groups [group A:3.95 ±0.34,0.73 ±0.05,(36.60 ±5.21)％,(125.36 ±44.38) ml;group B:3.65 ±0.29,0.66 ±0.07,(41.34 ±6.19)％,(110.72 ±50.39) ml;group C:3.32 ±0.25,0.60 ±0.05,(48.25 ±5.68)％,(90.47 ±33.64) ml;group D:3.07 ±0.26,0.52 ±0.04,(56.47 ±7.12)％,(72.49 ±38.36) ml](P＜ 0.05).The incidence rate of cardiogenic death in group A was significantly higher than that in the other three groups [56.8％ (21/37) vs.23.3％ (17/73),17.9％ (10/56),13.2％ (5/38)] (P ＜ 0.05).The smoking rate,NYHA cardiac function class Ⅳ,triglyceride (TG),uric acid,fasting blood glucose (FBG),2 h postprandial blood glucose (PBG),glycosylated hemoglobin (HbA1c),creatinine,lgNT-proBNP,cardiothoracic ratio,LVEDV in death group were significantly higher than those in survival group,high-density lipoprotein cholesterol (HDL-C),LVEF and SBP were lower than those in survival group [(0.85 ± 0.29) mmol/L vs.(1.12 ±0.36) mmol/L,(40.28 ±5.62)％ vs.(51.75 ±8.96)％,(124.38 ±22.67) mmHg vs.(141.57 ±24.39) mmHg],and the difference had statistical significance (P ＜0.05).Pearson correlation analysis showed that SBP was negatively correlated with lgNT-proBNP,C/T,LVEDV (r =-0.379,-0.498,-0.413,P ＜0.05),and positively correlated with LVEF(r =0.625,P ＜ 0.05).Multiple linear regression analysis results showed that the LVEF,creatinine,SBP (OR =0.942,0.829,1.033) and the prognosis of acute attack of chronic heart failure had obvious relationship.Conclusion Level of SBP is an important index reflecting cardiac function and prognosis in elderly patients with acute attack of chronic heart failure. Key words: Aged;  Heart failure;  Blood pressure;  Prognosis;  Cardiac function