老年射血分数保留型心衰合并冠心病患者右心室-动脉解耦联特征分析OA

Objective To investigate the characteristics of right ventricular(RV)-arterial uncoupling in elderly patients with heart failure with preserved ejection fraction(HFpEF)accompanied by coronary artery disease(CAD),and to clarify the differences in related factors for RV-arterial uncoupling between elderly and non-elderly patients.Methods A total of 404 patients with HFpEF accompanied by CAD admitted to the Department of Cardiology of the First Hospital of Qinhuangdao from May 2021 to May 2022 were consecutively enrolled.Patients aged ≥70 years were defined as the elderly group,while RV-arterial uncoupling was defined as a tricuspid annular plane systolic excursion to pulmonary artery systolic pressure(TAPSE/PASP)ratio ≤0.43.Logistic regression was used to identify factors associated with uncoupling,and the area under the ROC curve(AUC)of each factor was compared between the elderly and non-elderly groups to analyze intergroup differences.Results Among 404 HFpEF patients with CAD,a total of 148 elderly patients had a median age of 74(72,77)years,of whom 65.5％were male.Compared with the elderly RV-arterial coupling group(69 patients),patients in the elderly RV-arterial uncoupling group(79 patients)had significantly decreased TAPSE and markedly elevated PASP,and significant differences were observed between the two groups in baseline profiles,laboratory indicators and echocardiographic parameters(all P＜0.05).Multi variable logistic regression analysis revealed that history of hypertension,atrial fibrillation,coronary artery bypass grafting,use of diuretics,interleukin-6,total cholesterol,NT-proBNP,E/e',IVC,and RAD were positively correlated with RV-arterial uncoupling,while BMI,RDW-SD and serum albumin were negatively correlated with RV-arterial uncoupling in HFpEF patients with CAD(all P＜0.05).Specifically,NT-proBNP and serum albumin＜40 g/L exerted a more significant effect on the occurrence of RV-arterial uncoupling in elderly patients than in non-elderly patients[AUC(95％CI),0.791(0.710-0.857)vs.0.687(0.615-0.757),P=0.048;0.637(0.562-0.712)vs.0.492(0.442-0.543),P=0.002].In contrast,RAD had a more pronounced impact on non-elderly patients[AUC(95％CI),0.597(0.498-0.689)vs.0.723(0.655-0.785),P=0.034].Conclusion In elderly patients with HFpEF accompanied by CAD,the clinical characteristics differ between the RV-arterial uncoupling group and the coupling group.RV-arterial uncoupling is associated with multiple clinical factors,and there are distinct specific differences in its related factors between elderly and non-elderly patients.