Ennezat Pierre V, Lefetz Yann, Maréchaux Sylvestre, Six-Carpentier Marie, Deklunder Ghislaine, Montaigne David, Bauchart Jean Jacques, Mounier-Véhier Claire, Jude Brigitte, Nevière Rémi, Bauters Christophe, Asseman Philippe, de Groote Pascal, Lejemtel Thierry H
Division of Cardiology, Centre Hospitalier Régional et Universitaire de Lille, and EA 2693, Université de Lille II, Faculté de Médecine, Lille, France.
J Card Fail. 2008 Aug;14(6):475-80. doi: 10.1016/j.cardfail.2008.02.012. Epub 2008 May 27.
The mechanisms that contribute to limit functional capacity are incompletely understood in patients with preserved resting ejection fraction (HFpREF). We assessed left ventricular (LV) systolic response to dynamic exercise in patients with HFpREF and in patients with similar comorbidities to HFpREF patients but without history or evidence of heart failure.
Twenty-five HFpREF patients in steady-state clinical condition without significant coronary artery disease and 25 hypertensive controls underwent exercise echocardiography. At rest, systolic pulmonary artery pressure, left atrial area, E/A and E/e' ratios were greater in patients with HFpREF than in control patients, whereas peak systolic mitral annular velocity was lower in HFpREF patients. The exercise-induced changes in LVEF, forward stroke volume, and cardiac output were significantly lower in HFpREF compared with control patients (-4 +/- 8 vs. +6 +/- 6 %, P = .001; -4 +/- 9 vs. +10 +/- 10 mL, P < .0001, and 1.6 +/- 1.2 vs. 3.5 +/- 1.8 L/min, P < .0001, respectively). Exercise-induced changes in effective arterial elastance significantly differed in HFpREF and control patients (0.5 +/- 0.6 vs. -0.2 +/- 0.5 mm Hg/mL, P < .0001). In addition, 7 of the 25 HFpREF patients developed functional mitral regurgitation during exercise and none in controls.
When compared with patients with similar comorbidities but without history or evidence of heart failure, patients with HFpREF experience greater arterial stiffening and thereby a deterioration of global LV systolic performance during dynamic exercise.
射血分数保留的心力衰竭（HFpREF）患者中，导致功能能力受限的机制尚未完全明确。我们评估了HFpREF患者以及合并症与HFpREF患者相似但无心力衰竭病史或证据的患者在动态运动时左心室（LV）的收缩反应。
25例处于稳态临床状态且无显著冠状动脉疾病的HFpREF患者和25例高血压对照者接受了运动超声心动图检查。静息时，HFpREF患者的收缩期肺动脉压、左心房面积、E/A和E/e'比值高于对照患者，而HFpREF患者的二尖瓣环峰值收缩速度较低。与对照患者相比，HFpREF患者运动诱导的左心室射血分数（LVEF）、每搏输出量和心输出量变化显著更低（分别为-4±8% 对 +6±6%，P = 0.001；-4±9 mL 对 +10±10 mL，P < 0.0001，以及1.6±1.2 L/min 对 3.5±1.8 L/min，P < 0.0001）。HFpREF患者和对照患者运动诱导的有效动脉弹性变化显著不同（0.5±0.6 mmHg/mL 对 -0.2±0.5 mmHg/mL，P < 0.0001）。此外，25例HFpREF患者中有7例在运动期间出现功能性二尖瓣反流，而对照者中无1例出现。
与合并症相似但无心力衰竭病史或证据的患者相比，HFpREF患者在动态运动期间出现更大程度的动脉僵硬度增加，从而导致整体左心室收缩功能恶化。
