衰弱对老年射血分数保留的心力衰竭患者左室舒张功能、认知功能和跌倒风险的影响

摘要 目的：观察衰弱对老年射血分数保留的心力衰竭（HFpEF）患者左室舒张功能、认知功能和跌倒风险的影响。方法：选择2021年1月至 2022年11月期间西安交通大学第一附属医院收治的176例老年HFpEF患者。根据衰弱情况将患者分为非衰弱组（n=92）、衰弱前期组（n=48）、衰弱组（n=36）。对比三组左室舒张功能[左心室射血分数（LVEF）、二尖瓣Ｅ峰血流速度（E）/二尖瓣Ａ峰血流速度（A）、左室收缩末期内径（LVESD）、E/二尖瓣环间隔侧和侧壁侧平均组织多普勒速度（e''）、左室舒张末期内径（LVEDD）]、认知功能[简易智能精神状态检查量表（MMSE）、蒙特利尔认知评估量表（MoCA）]、跌倒风险[汉化的预防老年人意外、死亡、伤害工具（STEADI）评分]以及心脏不良事件总发生率。结果：三组LVEF、LVEDD、LVESD、E/A组间对比未见统计学差异（P>0.05）。衰弱组、衰弱前期组的E/e''高于非衰弱组,且衰弱组高于衰弱前期组（P<0.05）。衰弱组、衰弱前期组的MMSE、MoCA评分低于非衰弱组,且衰弱组低于衰弱前期组（P<0.05）。衰弱组、衰弱前期组的跌倒风险评分高于非衰弱组,且衰弱组高于衰弱前期组（P<0.05）。衰弱组、衰弱前期组的心脏不良事件总发生率高于非衰弱组,且衰弱组高于衰弱前期组（P<0.05）。结论：衰弱可在一定程度上影响老年HFpEF患者左室舒张功能,降低患者的认知功能,增加跌倒风险和心脏不良事件总发生率。

Effects of Frailty on Left Ventricular Diastolic Function, Cognitive Function and Fall Risk in Elderly Patients with Heart Failure with Preserved Ejection Fraction

ABSTRACT Objective: To observe the effects of frailty on left ventricular diastolic function, cognitive function and fall risk in elderly patients with heart failure with preserved ejection fraction (HFpEF). Methods: 176 elderly HFpEF patients who were admitted to the First Affiliated Hospital of Xi''an Jiaotong University from January 2021 to November 2022 were selected. Patients were divided into non-frailty group (n=92), pre-frailty group (n=48) and frailty group (n =36) according to the frailty. The left ventricular diastolic function [left ventricular ejection fraction (LVEF), mitral E peak blood flow velocity (E)/mitral A peak blood flow velocity (A), left ventricular end systolic diameter (LVESD), E/mitral annular septal and lateral wall mean tissue Doppler velocity (e''), left ventricular end diastolic diameter (LVEDD)], cognitive function [mini mental state examination scale (MMSE), montreal cognitive assessment scale (MoCA)], fall risk [Chinese version of the prevention of accidents, deaths and injuries in the elderly (STEADI) score] and the total incidence of adverse cardiac events were compared among three groups. Results: There was no significant difference in LVEF, LVEDD, LVESD and E/A among three groups(P>0.05). The E/e'' in frailty group and pre-frailty group was higher than that in non-frailty group, and frailty group was higher than pre-frailty group(P<0.05). The MMSE and MoCA scores in frailty group and pre-frailty group were lower than those in non-frailty group, and frailty group was lower than pre-frailty group(P<0.05). The fall risk scores in frailty group and pre-frailty group were higher than those in non-frailty group, and frailty group was higher than pre-frailty group(P<0.05). The total incidence of adverse cardiac events in frailty group and pre-frailty group was higher than that in non-frailty group, and frailty group was higher than pre-frailty group(P<0.05). Conclusion: Frailty can affect the left ventricular diastolic function of elderly HFpEF patients to a certain extent, reduce the cognitive function of patients, and increase the risk of falls and the total incidence of adverse cardiac events.