摘要目的 总结≥85岁的高龄老年射血分数保留的心力衰竭(HFpEF)患者的尸检报告,分析其心肌淀粉样物质沉积的情况.方法 本研究为回顾性研究.病例来源于北京医院病理科资料库中2003年2月1日至2016年10月31日间的系统病理解剖资料和临床资料.研究共入选年龄≥85岁且符合其他标准的HFpEF患者28例,并将年龄、性别相匹配,生前未诊断心力衰竭(心衰)且死于非心血管疾病的患者15例作为对照组.取左心室及室间隔心肌组织,用刚果红染色和马松三色染色法检测淀粉样物质和心肌纤维化,分析两组患者心肌淀粉样物质沉积和心肌纤维化程度,并采用Kappa检验对二者进行一致性评价.结果 HFpEF组患者心脏质量为(452.7±107.7)g,对照组为(415.0±70.8)g,二者差异无统计学意义(t=-1.218,P=0.23).HFpEF组中有24例(24/28)刚果红染色阳性,对照组仅5例(5/15),二者差异有统计学意义(χ2=12.205,P<0.01).HFpEF组患者中7例(7/28)刚果红重度阳性,而对照组则没有重度阳性者.马松三色染色法结果显示,HFpEF组患者中19例(19/28)为中重度心肌纤维化,对照组8例(8/15)为中重度心肌纤维化,二者差异无统计学意义(χ2=1.019,P=0.35).对所有入选者的心肌纤维化程度与心肌淀粉样物质沉积程度进行一致性评价,Kappa值=0.2,P=0.820,提示二者并不一致.结论 ≥85岁的高龄老年人心肌有淀粉样物质沉积,且在HFpEF患者中的比例较高,其可能为老年人HFpEF的重要病因.心肌淀粉样变性与心肌纤维化无明显关联.

abstractsObjective To determine the frequency and extent of left ventricular amyloid deposition in patients aged over 85 years with heart failure and preserved ejection fraction (HFpEF). Methods A total of 43 patients aged 85 to 100 years old were enrolled in this study based on the autopsy database of Beijing Hospital from February 1, 2003 to October 31, 2016. The frequency and extent of left ventricular amyloid deposition and myocardial fibrosis were determined in left ventricular specimens from patients with antemortem diagnosis of HFpEF without clinically apparent amyloid (n=28) and from control subjects (n=15) post Congo red staining and Masson's trichrome staining. Kappa test was used to evaluate the consistency of the myocardial amyloidosis and fibrosis. Results The heart weight of the patients in HFpEF group and in control group were similar((452.7 ± 107.7)g vs. (415.0 ± 70.8)g, t=-1.218, P=0.23)). Positive Congo-red staining was found in 24 examples (24/28) in HFpEF group and 5 examples (5/15) in the control group;severe amyloid deposition was found in 7 examples (7/28) in HFpEF group, but not in the control group. Amyloid deposition was more severe in HFpEF group than in control group (χ2=12.205, P<0.01). Masson's trichrome staining evidenced moderate to severe fibrosis in 19 cases (19/28) in HFpEF group and 8 cases (8/15) in control group (χ2=1.019, P=0.35). A consistent evaluation of the degree of myocardial fibrosis and the degree of myocardial amyloid deposition in all selected participants was performed and results showed that these two parameters were not consistent (Kappa value=0.2, P=0.820). Conclusion Amyloid deposition is common in the elderly patients with heart failure and preserved ejection fraction, suggesting that myocardial amyloidosis may be related to the development of HFpEF. There is no significant correlation between myocardial amyloidosis and myocardial fibrosis in this cohort.