Aurigemma G P, Gottdiener J S, Shemanski L, Gardin J, Kitzman D
Department of Medicine, University of Massachusetts Medical School, Worceter 01655, USA.
J Am Coll Cardiol. 2001 Mar 15;37(4):1042-8. doi: 10.1016/s0735-1097(01)01110-x.
We sought to assess the ability of echocardiographic indices of systolic and diastolic function to predict incident congestive heart failure (CHF).
Noninvasive indices of subclinical systolic and/or diastolic dysfunction that can be used to identify patients in a transition phase between normal cardiac function and clinical CHF would be valuable. Though midwall shortening and Doppler mitral inflow patterns are seemingly well suited to predict subsequent CHF, the predictive value of these indices has not been investigated.
We studied 2,671 participants in the Cardiovascular Health Study who were free of coronary heart disease, CHF or atrial fibrillation. Clinical and quantitative echocardiographic data were obtained in all participants.
At a mean follow-up of 5.2 years (range 0 to 6 years), 170 participants (6.4% of the cohort) developed CHF. Although 96% of these participants had normal or borderline ejection fraction (EF) at baseline, only 57% had normal or borderline EF at the time of hospitalization. In multivariate modeling, fractional shortening at the endocardium (relative risk [RR] 1.85 per 10-unit decrease, confidence interval [CI] 1.27 to 2.39), fractional shortening at the midwall (RR 1.29 per five-unit decrease, 95% CI 1.11-1.51) and peak Doppler peak E (RR 1.15 for each 0.1 M/s increment; CI 1.02 to 1.21) independently predicted incident CHF. Both high and low Doppler E/A ratios were predictive of incident CHF.
Roughly half the occurrences of CHF in this population are associated with normal or borderline EF. Echocardiographic findings suggestive of subclinical contractile dysfunction and diastolic filling abnormalities are both predictive of subsequent CHF. The standard (FSendo) and refined (FSmw) parameters of systolic function performed similarly in this regard, though subjects with left ventricular hypertrophy and depressed FSmw are at particularly high risk for subsequent CHF.
我们旨在评估收缩和舒张功能的超声心动图指标预测充血性心力衰竭（CHF）发病的能力。
可用于识别处于正常心功能与临床CHF过渡阶段患者的亚临床收缩和/或舒张功能障碍的无创指标将很有价值。尽管室壁中层缩短和二尖瓣血流多普勒模式似乎很适合预测随后的CHF，但这些指标的预测价值尚未得到研究。
我们研究了心血管健康研究中的2671名参与者，他们无冠心病、CHF或心房颤动。所有参与者均获得了临床和定量超声心动图数据。
平均随访5.2年（范围0至6年），170名参与者（占队列的6.4%）发生了CHF。尽管这些参与者中有96%在基线时射血分数（EF）正常或临界，但住院时只有57%的人EF正常或临界。在多变量建模中，心内膜缩短分数（每降低10个单位相对风险[RR]为1.85，置信区间[CI]为1.27至2.39）、室壁中层缩短分数（每降低5个单位RR为1.29，95%CI为1.11 - 1.51）和多普勒E峰峰值（每增加0.1 m/s RR为1.15；CI为1.02至1.21）独立预测CHF发病。高和低多普勒E/A比值均能预测CHF发病。
该人群中约一半的CHF发生与EF正常或临界有关。提示亚临床收缩功能障碍和舒张期充盈异常的超声心动图表现均能预测随后的CHF。收缩功能的标准（FSendo）和精细（FSmw）参数在这方面表现相似，不过左心室肥厚且FSmw降低的受试者随后发生CHF的风险特别高。
