[Pathological characteristics of the heart and coronary artery from elderly heart failure patients with preserved ejection fraction and coronary artery disease].

Objective: To analyze the pathological feathers of the heart in elderly (60-99 years old) heart failure patients with preserved ejection fraction (HFpEF) and coronary artery disease (CAD) and to explore the misdiagnosis and missed diagnosis rates. Method: This retrospective study included 154 HFpEF (left ventricular ejection fraction (LVEF)≥50%) cases and 49 heart failure with reduced ejection fraction (HFrEF) (LVEF≤40%) cases aged 60-99 years old out of 1 485 consecutive autopsy cases. Pathological changes of the heart and coronary artery were compared between patients with HFpEF and HFrEF. The misdiagnosis and missed diagnosis rates of HFpEF were analyzed based on pathological examination. Results: Patients with HFpEF were older than those with HFrEF ((85.7±7.4) vs. (82.9±7.8) years old, P=0.017). Among all the cases, CAD was diagnosed in 105 (68.2%) HFpEF patients and 38 (77.6%) HFrEF patients. Compared with patients with HFrEF, HFpEF patients displayed less acute myocardial infarction (12.3%(19/154) vs. 59.2%(29/49), P<0.01) and more chronic myocardial ischemia (18.2%(28/154) vs. 6.1%(3/49), P=0.041). 51.9% (80/154) HFpEF and 71.4% (35/49) HFrEF patients (P=0.017) displayed >50% left anterior descending artery stenosis. Prevalence of >75% coronary arterial stenosis (51% (25/49) vs. 20.1%(31/154), P<0.001) and more than one vessel lesions (55.1%(27/49) vs. 33.8%(52/154), P=0.008) were significantly higher in HFrEF patients than in HFpEF patients. The misdiagnosis rate of CAD in HFpEF was 63.3% (31/49). Among HFpEF, the missed diagnosis rate of acute myocardial infarction was 57.9% (11/19) and the missed diagnosis rate of old myocardial infarction was 57.7% (45/78). Conclusions: CAD and chronic myocardial ischemia are common in elderly patients with HFpEF. Chronic myocardial ischemia may play an important role in the development of HFpEF of elderly CAD patients. Among HFpEF patients, the misdiagnosis rate of CAD and missed diagnosis rate of myocardial infarction are high, so the accurate evaluation of myocardial ischemia status is of great importance.目的： 分析老年射血分数保留的心力衰竭(HFpEF)患者合并冠心病的心脏病理学特征，并比较其临床诊断和病理诊断的差别。 方法： 回顾性分析1969年4月至2013年10月北京医院病理科资料库的系统解剖资料，共纳入60～99岁的老年HFpEF病例154例和射血分数降低的心力衰竭(HFrEF)病例49例，比较二者心脏病理改变和冠状动脉病变特点。并以病理诊断为金标准，分析HFpEF患者冠心病临床诊断的符合率。 结果： 入选的HFpEF病例平均年龄大于HFrEF病例[(85.7±7.4)岁比(82.9±7.8)岁，P＝0.017]。HFpEF病例冠心病的检出率为68.2%(105/154)，其中急性心肌梗死检出率低于HFrEF病例[12.3%(19/154)比59.2%(29/49)，P<0. 01]，慢性心肌缺血的检出率高于HFrEF病例[18.2%(28/154)比6.1%(3/49)，P＝0.041]。两类心力衰竭均以冠状动脉左前降支出现Ⅲ级及以上狭窄最为常见[51.9%(80/154)比71.4%(35/49)，P＝0.017]，但HFpEF检出Ⅳ级狭窄和多支病变的比例较低[20.1%(31/154)比51.0%(25/49)，P<0.01；33.8%(52/154)比55.1%(27/49)，P＝0.008]。HFpEF病例冠心病临床诊断的误诊率为63.3%(31/49)，急性心肌梗死和陈旧性心肌梗死的漏诊率分别为57.9%(11/19)和57.7%(45/78)。 结论： 老年HFpEF患者合并冠心病和慢性心肌缺血的比例较高，同时发现冠心病临床误诊率较高，而急性心肌梗死和陈旧性心肌梗死的临床漏诊率较高。应加强对老年HFpEF患者心肌血供状态的评估。.