Department of Cardiology, University Hospital of Dijon, Dijon, France.
Eur J Heart Fail. 2012 Mar;14(3):248-58. doi: 10.1093/eurjhf/hfr169. Epub 2012 Jan 29.
The purpose of the present study was too explore the role of interatrial dyssynchrony in heart failure with preserved ejection fraction (HFPEF).
For the case study we selected seven patients with severe HFPEF, with interatrial block on electrocardiogram (ECG), and a delayed and interrupted A wave on mitral Doppler. Echocardiographic left atrial (LA) volumes/functions, mitral E/A and E/e' ratios, mitral A wave duration/deceleration time, and interatrial mechanical delays (IAMDs) at tissue Doppler, were studied. We performed right heart catheterization, and an electrophysiological study (EPS) for the measurement of interatrial conduction delay (IACD) and left atrioventricular interval (LAVI). Mean IAMD was 106 ms. All the patients exhibited a restrictive mitral Doppler pattern, high E/A and E/e' ratios, and short A wave duration/deceleration time. Left atrial volume was increased, with severely depressed functions. Right heart catheterization showed severe post-capillary pulmonary hypertension. The EPS showed an IACD of 170 ± 20 ms, with a short LAVI. Left atrial pacing through the coronary sinus reduced the IACD to 25 ± 15 ms. In the pilot study, 29 patients with HFPEF were compared with 27 age-matched control patients. HFPEF patients had longer P waves, shorter A waves, and a longer IAMD than the controls. Prevalence of severe IAMD >60 ms was 59% in HFPEF and 0% in controls. In the HFPEF group, patients with an IAMD >60 ms had significantly shorter A waves and higher E/e' ratio.
Some HFPEF patients present with IACD, delayed LA systole, shortened LA emptying, decreased LA compliance, and increased filling pressures. Whether the condition of these patients could be improved by atrial resynchronization deserves further investigation.
本研究旨在探讨房间隔不同步在射血分数保留的心力衰竭（HFPEF）中的作用。
我们选择了 7 例心电图（ECG）存在房间阻滞且二尖瓣多普勒显示 A 波延迟和中断的严重 HFPEF 患者进行病例研究。我们研究了超声心动图左心房（LA）容积/功能、二尖瓣 E/A 和 E/e' 比值、二尖瓣 A 波持续时间/减速时间以及组织多普勒的房间隔机械延迟（IAMD）。我们进行了右心导管检查和电生理研究（EPS），以测量房间隔传导延迟（IACD）和左房-室间隔时间（LAVI）。平均 IAMD 为 106ms。所有患者均表现为限制性二尖瓣多普勒模式，E/A 和 E/e' 比值高，A 波持续时间/减速时间短。左心房容积增加，功能严重受损。右心导管检查显示严重的毛细血管后肺动脉高压。EPS 显示 IACD 为 170±20ms，LAVI 较短。经冠状窦左心房起搏可将 IACD 缩短至 25±15ms。在初步研究中，我们比较了 29 例 HFPEF 患者和 27 例年龄匹配的对照组患者。HFPEF 患者的 P 波较长，A 波较短，IAMD 较长。HFPEF 组中严重 IAMD >60ms 的患病率为 59%，而对照组为 0%。HFPEF 组中 IAMD >60ms 的患者 A 波明显缩短，E/e'比值更高。
一些 HFPEF 患者存在 IACD、LA 收缩延迟、LA 排空缩短、LA 顺应性降低和充盈压升高。这些患者的病情是否可以通过心房再同步化得到改善，值得进一步研究。
