van Heerebeek Loek, Borbély Attila, Niessen Hans W M, Bronzwaer Jean G F, van der Velden Jolanda, Stienen Ger J M, Linke Wolfgang A, Laarman Gerrit J, Paulus Walter J
Department of Physiology, Institute for Cardiovascular Research, VU Medical Center, Amsterdam, The Netherlands.
Circulation. 2006 Apr 25;113(16):1966-73. doi: 10.1161/CIRCULATIONAHA.105.587519. Epub 2006 Apr 17.
To support the clinical distinction between systolic heart failure (SHF) and diastolic heart failure (DHF), left ventricular (LV) myocardial structure and function were compared in LV endomyocardial biopsy samples of patients with systolic and diastolic heart failure.
Patients hospitalized for worsening heart failure were classified as having SHF (n=22; LV ejection fraction (EF) 34+/-2%) or DHF (n=22; LVEF 62+/-2%). No patient had coronary artery disease or biopsy evidence of infiltrative or inflammatory myocardial disease. More DHF patients had a history of arterial hypertension and were obese. Biopsy samples were analyzed with histomorphometry and electron microscopy. Single cardiomyocytes were isolated from the samples, stretched to a sarcomere length of 2.2 microm to measure passive force (Fpassive), and activated with calcium-containing solutions to measure total force. Cardiomyocyte diameter was higher in DHF (20.3+/-0.6 versus 15.1+/-0.4 microm, P<0.001), but collagen volume fraction was equally elevated. Myofibrillar density was lower in SHF (36+/-2% versus 46+/-2%, P<0.001). Cardiomyocytes of DHF patients had higher Fpassive (7.1+/-0.6 versus 5.3+/-0.3 kN/m2; P<0.01), but their total force was comparable. After administration of protein kinase A to the cardiomyocytes, the drop in Fpassive was larger (P<0.01) in DHF than in SHF.
LV myocardial structure and function differ in SHF and DHF because of distinct cardiomyocyte abnormalities. These findings support the clinical separation of heart failure patients into SHF and DHF phenotypes.
为辅助收缩性心力衰竭（SHF）与舒张性心力衰竭（DHF）的临床鉴别诊断，对收缩性和舒张性心力衰竭患者的左心室（LV）心内膜活检样本中的心肌结构和功能进行了比较。
因心力衰竭加重而住院的患者被分为SHF组（n = 22；左心室射血分数（EF）34±2%）或DHF组（n = 22；左心室射血分数62±2%）。所有患者均无冠状动脉疾病或活检提示的浸润性或炎性心肌疾病。更多DHF患者有动脉高血压病史且肥胖。对活检样本进行组织形态计量学和电子显微镜分析。从样本中分离单个心肌细胞，拉伸至肌节长度2.2微米以测量被动张力（Fpassive），并用含钙溶液激活以测量总张力。DHF患者的心肌细胞直径更大（20.3±0.6对15.1±0.4微米，P<0.001），但胶原容积分数同样升高。SHF患者心肌原纤维密度较低（36±2%对46±2%，P<0.001）。DHF患者的心肌细胞Fpassive较高（7.1±0.6对5.3±0.3 kN/m2；P<0.01），但其总张力相当。对心肌细胞给予蛋白激酶A后，DHF患者Fpassive的下降幅度大于SHF患者（P<0.01）。
SHF和DHF患者的左心室心肌结构和功能因心肌细胞异常不同而存在差异。这些发现支持将心力衰竭患者分为SHF和DHF两种表型的临床分类方法。
