Department of Medicine, Loyola University Chicago, Maywood, Illinois, USA.
Clin Cardiol. 2010 Dec;33(12):770-4. doi: 10.1002/clc.20824.
Despite the common finding of diastolic dysfunction with a preserved ejection fraction on routine echocardiography in elderly patients, it is unknown why some patients with isolated diastolic dysfunction are asymptomatic whereas others develop diastolic heart failure (ie, signs and symptoms of congestive heart failure).
We hypothesized that renal insufficiency is more common in those patients with diastolic heart failure than those with diastolic dysfunction; it is intrinsic renal insufficiency that determines whether diastolic dysfunction becomes symptomatic.
We reviewed 686 consecutive transthoracic echocardiograms (TTEs). Patient age, race, weight, and cardiovascular risk factors (hypertension, diabetes, and coronary artery disease) were recorded. We used the Framingham Criteria for Congestive Heart Failure to determine the presence of diastolic heart failure by symptoms, exam findings, and radiological studies. Average creatinine clearance (CrCl), calculated by both total body weight and lean body mass, and estimated glomerular filtration rate (eGFR) were calculated for each group.
Of the 686 TTEs reviewed, 18 patients fulfilled the criteria for diastolic heart failure and 118 patients had asymptomatic diastolic dysfunction. There was no difference in age, race, or gender nor was there any difference in the echocardiographic variables of diastolic function or left ventricular hypertrophy between groups. Multiple regression analysis showed only lower CrCl (44 ± 36 mL/min vs 76 ± 42 mL/min, total body weight, P = 0.0015; and 31 ± 24 mL/min vs 51 ± 27 mL/min, lean body mass, P = 0.0012) and eGFR (44 ± 33 mL/min/M² vs 69 ± 28 mL/min/M², P = 0.0003) were associated with diastolic heart failure. There was no significant difference in the presence of hypertension, diabetes, and coronary artery disease between groups.
The results of this study support the hypothesis that patients with normal left ventricular ejection fractions but diastolic dysfunction develop congestive heart failure because of underlying renal insufficiency. A larger, prospective study is needed to confirm this hypothesis.
尽管在常规超声心动图检查中，老年患者常发现舒张功能障碍伴射血分数保留，但尚不清楚为什么一些孤立性舒张功能障碍患者无症状，而另一些患者则发展为舒张性心力衰竭（即充血性心力衰竭的体征和症状）。
我们假设舒张性心力衰竭患者比舒张功能障碍患者更常见肾功能不全；正是内在的肾功能不全决定了舒张功能障碍是否出现症状。
我们回顾了 686 例连续经胸超声心动图（TTE）。记录患者年龄、种族、体重和心血管危险因素（高血压、糖尿病和冠状动脉疾病）。我们使用弗雷明汉充血性心力衰竭标准通过症状、检查结果和影像学研究来确定舒张性心力衰竭的存在。使用全身重量和去脂体重计算平均肌酐清除率（CrCl）和估算肾小球滤过率（eGFR）。
在回顾的 686 例 TTE 中，18 例患者符合舒张性心力衰竭标准，118 例患者无症状舒张功能障碍。两组间年龄、种族或性别无差异，舒张功能和左心室肥厚的超声心动图变量也无差异。多元回归分析显示，只有较低的 CrCl（44 ± 36 mL/min 比 76 ± 42 mL/min，全身重量，P = 0.0015；31 ± 24 mL/min 比 51 ± 27 mL/min，去脂体重，P = 0.0012）和 eGFR（44 ± 33 mL/min/M² 比 69 ± 28 mL/min/M²，P = 0.0003）与舒张性心力衰竭相关。两组间高血压、糖尿病和冠状动脉疾病的发生率无显著差异。
这项研究的结果支持这样一种假设，即射血分数正常但舒张功能障碍的患者因潜在的肾功能不全而发展为充血性心力衰竭。需要更大的前瞻性研究来证实这一假设。
