Devereux R B, Roman M J, Liu J E, Welty T K, Lee E T, Rodeheffer R, Fabsitz R R, Howard B V
Department of Medicine, The New York Presbyterian Hospital-Weill Cornell Medical Center, New York 10021, USA.
Am J Cardiol. 2000 Nov 15;86(10):1090-6. doi: 10.1016/s0002-9149(00)01165-6.
In selected clinical series, > or = 50% of adults with congestive heart failure (CHF) do not have left ventricular (LV) systolic dysfunction. Little is known of the prevalence of this phenomenon in population samples. Therefore, clinical examination and echocardiography were used in the second examination of the Strong Heart Study (3,184 men and women, 47 to 81 years old) to identify 95 participants with CHF, 50 of whom had normal LV ejection fraction (EF) (> 54%), 19 of whom had mildly reduced EF (40% to 54%), and 26 of whom had EF < or = 40%. Compared with those with no CHF, participants with CHF and no, mild, or severe decrease in EF had higher creatinine levels (2.34 to 2.85 vs 1.01 mg/dl, p < 0.001) and higher prevalences of diabetes (60% to 70% vs 50%) and hypertension (75% to 96% vs 46%, p < 0.05). Compared with those with no CHF, participants with CHF and normal EF had prolonged deceleration time (233 vs 204 ms, p < 0.05) and a reduced E/A, whereas those with CHF and EF < or = 40% had short deceleration time (158 ms, p < 0.05) and high E/A (1.70, p < 0.001); patients with CHF and normal EF had higher LV mass (98 vs 84 g/m2, p < 0.001) and relative wall thickness (0.37 vs 0.35, p < 0.05) than those without CHF. Patients with CHF with normal EF were, compared with those without CHF or with CHF and EF < or = 40%, disproportionately women (mean 84% vs 63% and 42%, p < 0.001), older (mean 64 vs 60 years and 63 years, respectively, p < 0.01), had higher body mass index (mean 33.1 vs 31.0 and 27.7 kg/m2, p < 0.05), and higher systolic blood pressure (mean 137 vs 130 and 128 mm Hg, both p < 0.05). Thus, in a population-based sample, patients with CHF and normal LV EF were older and overweight, more often women, had renal dysfunction, impaired early diastolic LV relaxation, and concentric LV geometry, whereas patients with CHF and severe LV dysfunction were more often men, had lower body mass index, a restrictive pattern of LV filling, and eccentric LV hypertrophy.
在一些选定的临床系列研究中，≥50%的充血性心力衰竭（CHF）成年患者没有左心室（LV）收缩功能障碍。对于该现象在人群样本中的患病率知之甚少。因此，在强心脏研究的第二次检查中（3184名年龄在47至81岁之间的男性和女性），采用临床检查和超声心动图来确定95名CHF参与者，其中50人左心室射血分数（EF）正常（>54%），19人EF轻度降低（40%至54%），26人EF≤40%。与无CHF的参与者相比，CHF且EF无降低、轻度降低或重度降低的参与者肌酐水平更高（2.34至2.85 vs 1.01mg/dl，p<0.001），糖尿病患病率更高（60%至70% vs 50%），高血压患病率更高（75%至96% vs 46%，p<0.05）。与无CHF的参与者相比，CHF且EF正常的参与者减速时间延长（233 vs 204ms，p<0.05），E/A降低，而CHF且EF≤40%者减速时间短（158ms，p<0.05），E/A高（1.70，p<0.001）；CHF且EF正常的患者左心室质量高于无CHF者（98 vs 84g/m²，p<0.001），相对室壁厚度也更高（0.37 vs 0.35，p<0.05）。与无CHF或CHF且EF≤40%的患者相比，CHF且EF正常的患者女性比例过高（平均84% vs 63%和42%，p<0.001），年龄更大（平均64岁 vs 60岁和63岁，p<0.01），体重指数更高（平均33.1 vs 31.0和27.7kg/m²，p<0.05），收缩压更高（平均137 vs 130和128mmHg，p均<0.05）。因此，在基于人群的样本中，CHF且左心室EF正常的患者年龄更大且超重，女性更常见，存在肾功能障碍、左心室早期舒张功能受损和左心室向心性几何形态，而CHF且左心室功能严重障碍的患者男性更常见，体重指数更低，左心室充盈呈限制性模式，且有左心室离心性肥厚。
