Department of Cardiology and Pneumology, University of Göttingen, Germany.
Am Heart J. 2011 Apr;161(4):797-804. doi: 10.1016/j.ahj.2011.01.003.
Quality of life (QoL) is impaired in diastolic heart failure. Little is known about QoL in diastolic dysfunction (DD) without heart failure.
In the DIAST-CHF observational study, outpatients with risk factors for or a history of heart failure were included. In a cross-sectional analysis, we classified patients with preserved systolic function as having normal diastolic function (N, n = 264) or DD without (DD-, n = 957) or with (DD+, n = 321) elevated filling pressures according to echocardiography. Quality of life was evaluated by the Short Form 36 (SF-36) questionnaire.
Short Form 36 physical function (SF-36-PF) was worse in DD+ (mean ± SD 67.2 ± 25.6) than in DD- (76.2 ± 22.7, P < .05) than in N (mean ± SD 81.1 ± 23.5, P < .01). Other physical dimensions and the physical component score were also lower in DD, whereas the mental component score did not differ. The SF-36-PF correlated weakly with echocardiographic indicators of diastolic function. In multivariate linear regression controlling for age, sex, body mass index, depressiveness as assessed by Patient Health Questionnaire 9, N-terminal probrain-type natriuretic peptide, and midregional proadrenomedullin (MR-proADM), individual echocardiographic parameters or grade of DD was not independently associated with SF-36-PF, whereas the presence of DD+ was. Both N-terminal probrain-type natriuretic peptide and MR-proADM were independently associated with SF-36-PF, with MR-proADM showing the stronger association.
Physical dimensions of QoL are reduced in DD. Impaired SF-36-PF is only weakly associated with DD per se but rather seems to be contingent on the presence of elevated filling pressures. Biomarkers are more strongly and independently associated with SF-36-PF and may be more adequate surrogate markers of QoL in DD than echocardiographic measurements.
舒张性心力衰竭会损害生活质量（QoL）。对于没有心力衰竭的舒张功能障碍（DD）患者的 QoL 知之甚少。
在 DIAST-CHF 观察性研究中，纳入了有心力衰竭风险因素或心力衰竭病史的门诊患者。在一项横断面分析中，我们根据超声心动图将收缩功能正常的患者分为具有正常舒张功能（N，n=264）或无（DD-，n=957）或有（DD+，n=321）升高充盈压的 DD。通过简明健康状况调查问卷（SF-36）评估生活质量。
SF-36 身体功能（SF-36-PF）在 DD+（平均±SD，67.2±25.6）比 DD-（76.2±22.7，P<.05）和 N（平均±SD，81.1±23.5，P<.01）差。DD 患者的其他身体维度和身体成分评分也较低，而心理成分评分无差异。SF-36-PF 与舒张功能的超声心动图指标弱相关。在多元线性回归中，控制年龄、性别、体重指数、用患者健康问卷 9 评估的抑郁程度、N 末端脑钠肽前体、中区域 proadrenomedullin（MR-proADM）后，个别超声心动图参数或 DD 分级与 SF-36-PF 无关，但 DD+的存在有关。N 末端脑钠肽前体和 MR-proADM 均与 SF-36-PF 独立相关，MR-proADM 的相关性更强。
DD 患者的 QoL 身体维度降低。SF-36-PF 受损与 DD 本身仅呈弱相关，而是似乎取决于升高的充盈压的存在。生物标志物与 SF-36-PF 的相关性更强且更独立，与超声心动图测量相比，可能是 DD 患者 QoL 的更合适替代标志物。
