Department of Cardiology (Campus Virchow-Klinikum), Charité University Hospital, Humboldt University of Berlin, Augustenburger Platz 1, Berlin, Germany.
J Am Soc Echocardiogr. 2011 Jun;24(6):651-62. doi: 10.1016/j.echo.2011.02.004. Epub 2011 Mar 31.
The authors hypothesized that in patients with heart failure with normal left ventricular (LV) ejection fraction (HFNEF), the same fibrotic processes that affect the subendocardial layer of the left ventricle could also alter the subendocardial fibers of the left atrium. Consequently, these fibrotic alterations, together with chronically elevated LV filling pressures, would lead to both systolic and diastolic subendocardial dysfunction of the left atrium (i.e., impaired left atrial [LA] longitudinal systolic and diastolic function) in patients with HFNEF.
Patients with HFNEF and a control group consisting of asymptomatic patients with LV diastolic dysfunction (LVDD) matched by age, gender, and LV ejection fraction were studied using two-dimensional speckle-tracking echocardiography.
A total of 420 patients were included (119 with HFNEF and 301 with asymptomatic LVDD). LA longitudinal systolic (LA late diastolic strain rate) and diastolic (LA systolic strain and strain rate) function was significantly more impaired in patients with HFNEF (LA late diastolic strain rate, -1.17 ± 0.63 s(-1); LA systolic strain, 19.9 ± 7.3%; LA systolic strain rate, 1.17 ± 0.46 s(-1)) compared with those with asymptomatic LVDD (-1.80 ± 0.70 s(-1), 30.8 ± 11.4%, and 1.67 ± 0.59 s(-1), respectively) (all P values < .0001). On multiple regression analysis, LV global longitudinal systolic strain and diastolic strain rate were the most important independent predictors of LA longitudinal systolic and diastolic function, in contrast to noninvasive LV filling pressures (i.e., mitral E/e' average septal-lateral ratio), which were modestly related to LA longitudinal systolic and diastolic function. Furthermore, in patients with HFNEF, the subendocardial function of both the left atrium and the left ventricle was significantly impaired in high proportions. In that regard, in patients with HFNEF, the rate of LA longitudinal systolic and diastolic dysfunction was 65.5% and 28.5%, whereas the prevalence of LV longitudinal systolic and diastolic dysfunction was 81.5% and 58%, respectively. In addition, patients with both systolic and diastolic longitudinal dysfunction of the left atrium presented worse NYHA functional class as compared with those with normal LA longitudinal function.
In patients with HFNEF, LA subendocardial systolic and diastolic dysfunction is common and possibly associated with the same fibrotic processes that affect the subendocardial fibers of the left ventricle and to a lesser extent with elevated LV filling pressures. Furthermore, these findings suggest that LA longitudinal systolic and diastolic dysfunction could be related to reduced functional capacity during effort in patients with HFNEF.
作者假设，在射血分数正常的心力衰竭（HFNEF）患者中，影响左心室心内膜下层的相同纤维化过程也可能改变左心房的心内膜下纤维。因此，这些纤维化改变，加上慢性升高的左心室充盈压，将导致 HFNEF 患者的左心房（LA）心内膜下收缩和舒张功能障碍（即，LA 纵向收缩和舒张功能受损）。
使用二维斑点追踪超声心动图研究 HFNEF 患者和由年龄、性别和左心室射血分数匹配的无症状左心室舒张功能障碍（LVDD）患者的对照组。
共纳入 420 例患者（HFNEF 患者 119 例，无症状 LVDD 患者 301 例）。HFNEF 患者的 LA 纵向收缩（LA 舒张晚期应变率）和舒张功能（LA 收缩应变和应变率）明显受损（LA 舒张晚期应变率，-1.17±0.63 s(-1)；LA 收缩应变，19.9±7.3%；LA 收缩应变率，1.17±0.46 s(-1))，与无症状 LVDD 患者相比（LA 舒张晚期应变率，-1.80±0.70 s(-1)；LA 收缩应变，30.8±11.4%；LA 收缩应变率，1.67±0.59 s(-1)）（所有 P 值均<0.0001）。多元回归分析显示，LV 整体纵向收缩应变和舒张应变率是 LA 纵向收缩和舒张功能的最重要独立预测因子，而非侵入性 LV 充盈压（即二尖瓣 E/e'平均间隔-侧壁比）仅与 LA 纵向收缩和舒张功能中度相关。此外，在 HFNEF 患者中，左心房和左心室的心内膜下功能均有显著受损。在这方面，HFNEF 患者 LA 纵向收缩和舒张功能障碍的发生率分别为 65.5%和 28.5%，而 LV 纵向收缩和舒张功能障碍的发生率分别为 81.5%和 58%。此外，与 LA 纵向功能正常的患者相比，左心房纵向收缩和舒张功能障碍的患者 NYHA 心功能分级更差。
在 HFNEF 患者中，LA 心内膜下收缩和舒张功能障碍很常见，可能与影响左心室心内膜下纤维的相同纤维化过程有关，与升高的 LV 充盈压的关系较小。此外，这些发现表明，LA 纵向收缩和舒张功能障碍可能与 HFNEF 患者用力时的功能能力降低有关。
