Objective: To analyze whether there is a difference in the influence of coronary artery disease (CAD) on the clinical features and prognosis of three different types of heart failure patients. Methods: Complete clinical data of 1 520 hospitalized patients with heart failure from Tianjin Medical University General Hospital and Tianjin Chest Hospital from March 2014 to February 2016 was retrospectively reviewed. According to left ventricular ejection fraction (LVEF), the patients were divided into three groups: heart failure with reduced ejection fraction group (HFrEF), heart failure with mid-range ejection fraction group (HFmrEF)and heart failure with preserved ejection fraction group (HFpEF). Each group was further classified into two subgroups according to absence or presence of CAD (No CAD' and 'With CAD'). In the HFrEF group, 197 patients were categorized into 'No CAD' sub-group while 435 patients were into 'With CAD' sub-group. Likewise, 63 patients in HFmrEF group fell into 'No CAD' sub-group while 367 were into 'With CAD' sub-group. Seventy two patients in the HFpEF group were in the 'No CAD' sub-group with 386 in the 'With CAD' sub-group. Clinical features and 2-year prognosis between different subgroups were compared. Results: (1) The relationship between CAD and clinical features of different types of heart failure: the proportions of HFrEF, HFmrEF and HFpEF combined with CAD were 68.8%, 85.3% and 84.3%, respectively (P<0.05). Compared with the 'No CAD' subgroups, patients in the 'With CAD' subgroups were older, and had higher NT-proBNP levels, higher rates of hypertension and diabetes, and lower rates of atrial fibrillation. Also, there were more use of antiplatelet and nitrate drugs in the 'With CAD' sub-groups (P<0.05). (2) Risk of different types of heart failure combined with CAD: after multivariate adjustment, HFrEF had a lower risk of CAD (HFrEF vs HFmrEF: RR=0.389, 95%CI 0.281-0.540; HFrEF vs HFpEF: RR=0.408, 95%CI 0.298-0.560). (3)The influence of CAD on the prognosis of different types of heart failure: CAD increased the risk of mortality in the HFrEF group (HR=1.631, 95%CI 1.119-2.377), and cardiovascular events in all three types of heart failure (HR: HFrEF 1.725, 95%CI 1.325-2.246; HFmrEF 1.815, 95%CI 1.144-2.879; HFpEF 1.900, 95%CI 1.218-2.963). Conclusions: Patients with HFmrEF and HFpEF have a higher prevalence and risk of CAD than patients with HFrEF. CAD is associated with an increased risk of cardiovascular events in all types of heart failure and increases the risk of all-cause mortality among HFrEF group. CAD is an important factor influencing the clinical features and prognosis of patients with all types of heart failure.
目的： 分析冠心病（CAD）对三种不同类型心力衰竭（简称心衰）患者临床特征及预后的影响是否存在差异。 方法： 采用回顾性队列研究方法，纳入天津医科大学总医院和天津胸科医院两所医院2014年3月至2016年2月期间以心衰为主要病因、NYHA心功能分级Ⅱ-Ⅳ、且临床资料完整的住院心衰患者资料，共计1 520例。按照左室射血分数（LVEF）不同分为射血分数减低心衰（HFrEF；LVEF<40%）、射血分数中间值心衰（HFmrEF；LVEF40%~49%）和射血分数保留心衰（HFpEF；LVEF≥50%）3组，每组根据是否合并CAD再各分两个亚组，其中，HFrEF不合并CAD组197例，HFrEF合并CAD组435例，HFmrEF不合并CAD组63例，HFmrEF合并CAD组367例，HFpEF不合并CAD组72例，HFpEF合并CAD组386例。比较各类型心衰不同亚组间临床特征及2年预后差异。 结果： （1）CAD与不同类型心衰临床特征的关系：HFrEF、HFmrEF和HFpEF合并CAD的比率分别为68.8%、85.3%和84.3%（P<0.05）；与不合并CAD亚组相比，三个合并CAD亚组年龄更大，NT-proBNP水平更高，同时合并高血压、糖尿病的比率更高，合并房颤比率更低，更多使用抗血小板和硝酸酯类药物（均P<0.05）。（2）不同类型心衰合并CAD的风险：经多变量调整后，HFrEF有较低的患CAD的风险[HFrEF比HFmrEF：风险比（RR）=0.389，95%CI 0.281~0.540；HFrEF比HFpEF：RR=0.408，95%CI 0.298~0.560]。（3）CAD对不同类型心衰预后的影响：CAD增加了HFrEF组的全因死亡风险（HR=1.631，95%CI 1.119~2.377），CAD增加了所有3个类型心衰的心血管事件的风险（HR分别为：HFrEF 1.725，95%CI 1.325~2.246；HFmrEF 1.815，95%CI 1.144~2.879；HFpEF 1.900，95%CI 1.218~2.963）。 结论： HFmrEF和HFpEF患者较HFrEF患者有更高的CAD的患病率及患病风险，CAD与所有类型的心衰的心血管事件的风险增加相关，并且增加了HFrEF的全因死亡风险。CAD是各种类型心衰患者临床特征及预后的重要影响因素。.
Keywords: Coronary artery disease; Heart failure; Mid-range left ventricular ejection fraction; Preserved left ventricular ejection fraction; Reduced left ventricular ejection fraction.