Bronzwaer Jean G F, Paulus Walter J
Department of Physiology, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.
Curr Heart Fail Rep. 2009 Dec;6(4):281-6. doi: 10.1007/s11897-009-0038-0.
It remains uncertain if diastolic heart failure (DHF) is a distinct HF phenotype or a precursor stage of systolic HF (SHF). The unimodal distribution of left ventricular ejection fraction (LVEF) in HF, depressed LV long-axis shortening in DHF, and progression to eccentric LV remodeling in hypertension favor DHF and SHF as successive stages. These arguments are countered by the bimodal distribution of LVEF after correction for gender, by the preserved LV twist in DHF and by the low incidence of eccentric LV remodeling in hypertension. Clinical features, LV anatomy and histology, cardiomyocyte stiffness, myocardial effects of diabetes, and the response to HF therapy support DHF and SHF as distinct phenotypes. Comparison of the myocardial signal transduction cascades that drive LV remodeling in DHF and SHF may solve the controversy. This review analyzes arguments supporting DHF and SHF as successive stages or distinct phenotypes of the HF syndrome.
舒张性心力衰竭（DHF）究竟是一种独特的心力衰竭表型还是收缩性心力衰竭（SHF）的前驱阶段，目前仍不明确。心力衰竭患者左心室射血分数（LVEF）的单峰分布、DHF中左心室长轴缩短程度降低以及高血压患者向偏心性左心室重构进展等情况，支持DHF和SHF为连续阶段。但在校正性别后LVEF的双峰分布、DHF中保留的左心室扭转以及高血压患者中偏心性左心室重构的低发生率等情况则反驳了上述观点。临床特征、左心室解剖结构和组织学、心肌细胞僵硬度、糖尿病对心肌的影响以及对心力衰竭治疗的反应等均支持DHF和SHF为不同的表型。比较驱动DHF和SHF中左心室重构的心肌信号转导级联反应可能会解决这一争议。本综述分析了支持DHF和SHF为心力衰竭综合征的连续阶段或不同表型的观点。
