舒张性心力衰竭患者的舒张期和收缩期不同步：一种常见但被忽视的情况。
Diastolic and systolic asynchrony in patients with diastolic heart failure: a common but ignored condition.
作者信息
Yu Cheuk-Man, Zhang Qing, Yip Gabriel W K, Lee Pui-Wai, Kum Leo C C, Lam Yat-Yin, Fung Jeffrey Wing-Hong
机构信息
Li Ka Shing Institute of Health Sciences, S.H. Ho Cardiovascular and Stroke Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, People's Republic of China.
出版信息
J Am Coll Cardiol. 2007 Jan 2;49(1):97-105. doi: 10.1016/j.jacc.2006.10.022. Epub 2006 Nov 1.
OBJECTIVES
The present study aimed to examine whether diastolic and systolic asynchrony exist in diastolic heart failure (DHF) and their prevalence and relationship to systolic heart failure (SHF) patients.
BACKGROUND
Few data exist on mechanical asynchrony in DHF.
METHODS
Tissue Doppler echocardiography was performed in 373 heart failure patients (281 with SHF and 92 with DHF) and 100 normal subjects. Diastolic and systolic asynchrony was determined by measuring the standard deviation of time to peak myocardial systolic (Ts-SD) and peak early diastolic (Te-SD) velocity using a 6-basal, 6-mid-segmental model, respectively.
RESULTS
Both heart failure groups had prolonged Te-SD (DHF vs. SHF vs. controls subjects: 32.2 +/- 18.0 ms vs. 38.0 +/- 25.2 ms vs. 19.5 +/- 7.1 ms) and Ts-SD (31.8 +/- 17.0 ms vs. 36.7 +/- 15.2 ms vs. 17.6 +/- 7.9 ms) compared with the control group (all p < 0.001 vs. control subjects). Based on normal values, the DHF group had comparable diastolic (35.9% vs. 43.1%; chi-square = 1.48, p = NS), but less systolic asynchrony than the SHF group (39.1% vs. 56.9%; chi-square = 8.82, p = 0.003). Normal synchrony, isolated systolic, isolated diastolic, and combined asynchrony were observed in 39.1%, 25.0%, 21.7%, and 14.1% of DHF patients, respectively, and these were 25.6%, 31.3%, 17.4%, and 25.6%, correspondingly, in SHF (chi-square = 10.01, p = 0.019). The correlation between systolic and diastolic asynchrony, and between the myocardial velocities and corresponding mechanical asynchrony appeared weak. A wide QRS duration (>120 ms) was rare in DHF (10.9% vs. 37.7% in SHF) (chi-square = 16.69, p < 0.001).
CONCLUSIONS
Diastolic and/or systolic asynchrony was common in 61% of DHF patients despite narrow QRS complex. The presence of asynchrony was not related to myocardial systolic or diastolic function. Systolic and diastolic asynchrony were not tightly coupled, implying distinct mechanisms.
目的
本研究旨在探讨舒张性心力衰竭（DHF）患者是否存在舒张期和收缩期不同步，以及其发生率及其与收缩性心力衰竭（SHF）患者的关系。
背景
关于DHF患者机械不同步的数据较少。
方法
对373例心力衰竭患者（281例SHF患者和92例DHF患者）及100名正常受试者进行组织多普勒超声心动图检查。分别采用6个基底节段和6个中间节段模型测量心肌收缩期峰值速度时间标准差（Ts-SD）和舒张早期峰值速度时间标准差（Te-SD），以确定舒张期和收缩期不同步情况。
结果
与对照组相比，两组心力衰竭患者的Te-SD（DHF组vs. SHF组vs.对照组：32.2±18.0毫秒vs. 38.0±25.2毫秒vs. 19.5±7.1毫秒）和Ts-SD（31.8±17.0毫秒vs. 36.7±15.2毫秒vs. 17.6±7.9毫秒）均延长（与对照组相比，p均<0.001）。以正常值为标准，DHF组舒张期不同步发生率与SHF组相当（35.9% vs. 43.1%；卡方检验=1.48，p=无统计学意义），但收缩期不同步发生率低于SHF组（39.1% vs. 56.9%；卡方检验=8.82，p=0.003）。DHF患者中，正常同步、单纯收缩期不同步、单纯舒张期不同步和联合不同步的发生率分别为39.1%、25.0%、21.7%和14.1%，SHF患者相应发生率分别为25.6%、31.3%、17.4%和25.6%（卡方检验=10.01，p=0.019）。收缩期和舒张期不同步之间以及心肌速度与相应机械不同步之间的相关性较弱。DHF患者中QRS波时限增宽（>120毫秒）较少见（10.9% vs. SHF患者中的37.7%）（卡方检验=16.69，p<0.001）。
结论
尽管QRS波时限窄，但61%的DHF患者存在舒张期和/或收缩期不同步。不同步的存在与心肌收缩或舒张功能无关。收缩期和舒张期不同步并非紧密相关，提示存在不同机制。
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