Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, People's Republic of China.
Eur Heart J. 2010 Nov;31(21):2642-9. doi: 10.1093/eurheartj/ehq248. Epub 2010 Jul 28.
The impact of haemodynamic stress on left ventricular (LV) dyssynchrony in heart failure with normal ejection fraction (HFNEF) remains unknown. We sought to evaluate the relationship and predictive value of dynamic changes of LV dyssynchrony on hypertensive HFNEF.
A total of 131 subjects including 47 hypertensive HFNEF patients, 34 hypertensive patients with left ventricular hypertrophy (LVH) without HFNEF, and 50 normal controls were studied by dobutamine stress echocardiography with tissue Doppler imaging. Systolic and diastolic dyssynchrony were assessed using the LV six-basal-six-mid-segment model and cut-off values were derived from normal controls. The mean basal segments longitudinal systolic (mean Sm) and early diastolic (mean Em) velocities were measured. In normal controls, systolic and diastolic dyssynchrony did not develop during stress. The prevalence of resting systolic (36.2% vs. 38.2%, P = 0.85) and diastolic (34.0% vs. 29.4%, P = 0.66) dyssynchrony was similar in HFNEF and LVH groups. During stress, the prevalence of systolic and diastolic dyssynchrony increased dramatically to 85.1% and 87.2%, respectively, in HFNEF group, but only 52.9% and 58.8% in LVH group (P < 0.005). In HFNEF group, stress-induced increase in mean Sm was significantly blunted (2.8 ± 2.0 vs. 4.2 ± 2.4 cm/s, P = 0.004), and the increase was abolished for mean Em (-0.3 ± 2.5 vs. 2.4 ± 3.4 cm/s, P < 0.001). On multivariate analysis, stress-induced changes in mean Em (OR = 0.69, P = 0.004) and mean Sm (OR = 0.56, P = 0.004), and diastolic (OR = 4.6, P = 0.005) and systolic dyssynchrony during stress (OR = 4.3, P = 0.038) were independent determinants for occurrence of HFNEF.
Dynamic dyssynchrony during stress and impaired myocardial longitudinal function reserve are characteristics of HFNEF.
血流动力学应激对射血分数正常心力衰竭（HFNEF）患者左心室（LV）不同步的影响尚不清楚。本研究旨在评估 LV 不同步的动态变化与高血压 HFNEF 的关系及其预测价值。
共纳入 131 例受试者，包括 47 例高血压 HFNEF 患者、34 例高血压左心室肥厚（LVH）无 HFNEF 患者和 50 例正常对照者。所有患者均行多巴酚丁胺超声心动图检查，采用组织多普勒成像技术评估收缩和舒张不同步。采用 LV 六节段基底段-中段模型评估收缩期和舒张期不同步，正常对照组中采用该模型得出截断值。测量平均基底段纵向收缩期（平均 Sm）和早期舒张期（平均 Em）速度。在正常对照组中，应激过程中并未出现收缩期和舒张期不同步。HFNEF 组和 LVH 组静息时收缩期（36.2%比 38.2%，P=0.85）和舒张期（34.0%比 29.4%，P=0.66）不同步的发生率相似。HFNEF 组应激时收缩期和舒张期不同步的发生率显著增加至 85.1%和 87.2%，而 LVH 组仅为 52.9%和 58.8%（P<0.005）。HFNEF 组，应激时平均 Sm 的增加明显减弱（2.8±2.0 比 4.2±2.4 cm/s，P=0.004），平均 Em 的增加也完全消失（-0.3±2.5 比 2.4±3.4 cm/s，P<0.001）。多变量分析显示，应激时平均 Em 的变化（OR=0.69，P=0.004）、平均 Sm 的变化（OR=0.56，P=0.004）、舒张期（OR=4.6，P=0.005）和收缩期不同步（OR=4.3，P=0.038）是 HFNEF 发生的独立决定因素。
应激时动态不同步和纵向心肌功能储备受损是 HFNEF 的特征。
