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characteristics，prognosis and prognostic predictors in Chinese HFimpEF patients. Methods Participants included in this case-
control study were chronic HF inpatients who were recruited from Department of Heart Center，Hebei General Hospital from June 1，
2018，to May 1，2020. Demographic data and baseline clinical information were obtained from the electronic medical record，in
particular，clinical phenotypes of HF classified by baseline and follow-up LVEF included four：HF with preserved EF（HFpEF），
HF with mid-range EF（HFmrEF），HF with reduced EF（HFrEF） and HFimpEF. Follow-up was conducted via electronic
medical record review，outpatient department and telephone since the last reexamination with echocardiography. The follow-up
continued through 2021-06-01，with all-cause death and all-cause readmission as endpoint events. Predictors of HFimpEF were
explored by binary Logistic regression. Kaplan-Meier estimator was used to describe the survival of patients with all-cause death
and all-cause readmission. Cox regression model was used to identify risk factors for all-cause death and all-cause readmission.
Results A total of 530 cases were included，including 245（46.2%） with HFpEF，55（10.4%） with HFmrEF，133（25.1%）
with HFrEF，and 97（18.3%） with HFimpEF. HFimpEF patients had lower mortality than did HFpEF patients（P=0.014）
and HFmrEF patients（P<0.001）. The readmission rate was lower in HFimpEF patients than that of HFpEF（P=0.011）or
HFmrEF patients（P=0.001）. Elevated systolic blood pressure〔OR=1.036，95%CI（1.019，1.053），P<0.001〕，and left
ventricular end-systolic diameter（LVESD） ≤ 37 mm〔OR=0.245，95%CI（0.118，0.507），P<0.001〕 at baseline，and
treatments with beta-blockers〔OR=2.868，95%CI（1.304，6.305），P=0.009〕 and aldosterone antagonists〔OR=2.691，
95%CI（1.316，5.503），P=0.007〕 were associated with increased probability of LVEF improvement. HFrEF，older age，
heart valve disease，chronic kidney disease，anemia，non-use of beta-blockers and oral anticoagulants were independently
associated with increased risk of all-cause death in HF patients（P<0.05）. HFpEF，HFmrEF and chronic kidney disease
were independently associated with increased risk of all-cause readmission in HF patients（P<0.05）. Concomitant valvular
heart disease〔HR=6.499，95%CI（1.504，28.089），P=0.012〕and anemia〔HR=4.884，95%CI（1.242，19.208），
P=0.023〕were independently associated with increased risk of all-cause death in HFimpEF patients. The use of beta-blockers
〔HR=2.868，95%CI（1.304，6.305）P=0.009〕 and aldosterone antagonists〔HR=2.691，95%CI（1.316，5.503），
P=0.007〕 were associated with increased probability of LVEF improvement. Conclusion We consider that HFimpEF is a
clinical phenotype of HF manifested as milder clinical symptoms，less ventricular remodelling and a better prognosis. Elevated
systolic blood pressure，LVESD ≤ 37 mm and treatments with beta-blockers and aldosterone receptor antagonists may be
independent predictors of improved LVEF，while valvular heart disease and anaemia may be risk factors for all-cause death in
HFimpEF patients.
【Key words】 Heart failure；Cardiovascular diseases；Left ventricular ejection fraction；Ventricular remodeling；
Improved ejection fraction；Disease attributes；Prognosis；Root cause analysis；Survival analysis

在各国指南中，左心室射血分数（left ventricular 1 资料与方法
ejection fraction，LVEF） 常 被 作 为 心 力 衰 竭（heart 1.1 研究设计与人群 选取 2018 年 6 月至 2020 年 5
failure，HF）分类的依据 ［1-3］ 。但 LVEF 并非一成不 月在河北省人民医院心内科住院治疗的慢性心力衰竭
变，随着治疗手段的进步，临床经常可以观察到 LVEF （chronic heart failure，CHF）患者。从电子病历中获取
发生改善，即某些患者可能从较低 LVEF 过渡到较 患者的人口学特征和基线临床信息：人口学数据包括年
高 LVEF，由此产生了射血分数改善的 HF（HF with 龄、性别等；基线临床信息包括体格检查〔体质指数
improved EF，HFimpEF） 这 一 概 念。 有 研 究 发 现， （body mass index，BMI）、血压、心率、纽约心脏病
HFimpEF 临床特点及预后与其他类型的 HF 不同，然而 协会（NYHA）Ⅲ / Ⅳ级等〕、吸烟史、合并疾病（扩
这一临床表型始终缺乏统一的定义 ［4-6］ 。最近多国心力 张型心肌病、肥厚型心肌病、心房颤动、高血压、冠心
衰竭学会联合发布了 HF 普遍定义专家共识，将 HF 分 病、心脏瓣膜病、糖尿病、慢性肾脏病、高尿酸血症、
为四类，在原有基础上增加了 HFimpEF，并定义为： 低蛋白血症、血脂异常、贫血等）、超声心动图指标
基线 LVEF ≤ 40%，第二次测量时 LVEF 比基线增加 〔LVEF、左心室收缩末内径（left ventricular end systolic
≥ 10%，且 LVEF>40% ［7］ 。但迄今为止，相关的研究 diameter，LVESD）、左心室舒张末内径（left ventricular
多集中于欧美国家，我国关于此类人群的报道较少，本 end diastolic diameter，LVEDD）等〕、实验室指标〔血
+
研究依据上述专家共识中 HFimpEF 的定义，旨在对我 红蛋白、红细胞计数、血小板计数、血清 K 、肌酐、
国 HFimpEF 患者的临床特点和预后进行分析，以期为 氨基末端脑利钠肽前体（NT-proBNP）、估算肾小球滤
此类人群的防治提供循证医学依据。 过率（eGFR）、肌酸激酶同工酶（CK-MB）〕、治疗