Department of Cardiology (Campus Virchow-Klinikum) of the Charité University Hospital, Augustenburger Platz 1, Berlin, Germany.
Circ Heart Fail. 2012 Sep 1;5(5):610-20. doi: 10.1161/CIRCHEARTFAILURE.112.966564. Epub 2012 Aug 8.
The aim of this study was to investigate the myocardial systolic and diastolic performance of the left ventricle (LV) in patients with heart failure with normal LV ejection fraction (HFNEF) through novel LV myocardial indices, which assess the systolic and diastolic function of the whole myocardium of the LV.
LV myocardial systolic and diastolic performance were assessed as the average value of peak systolic strain and peak early-diastolic strain rate, respectively, in longitudinal, circumferential, and radial directions from all LV segments using 2-dimensional speckle-tracking echocardiography. We studied patients with HFNEF and a control group consisting of asymptomatic subjects with LV diastolic dysfunction of similar age, sex, and LV ejection fraction. A total of 322 patients were included (92 with HFNEF and 230 with asymptomatic LV diastolic dysfunction). Myocardial systolic and diastolic LV performance were significantly lower in HFNEF (20.13±6.02% and 1.14±0.27 s(-1)) than in patients with asymptomatic LV diastolic dysfunction (25.33±6.06% and 1.37±0.33 s(-1), respectively; all P<0.0001). In addition, patients with HFNEF with low systolic and diastolic LV myocardial performance had significantly higher LV filling pressures (17.1±6.6 and 17.6±6.3 versus 12.0±5.1 and 11.7±4.7, respectively; all P<0.001) and lower cardiac output (4.8±1.0 L/min and 4.9±1.1 L/min versus 5.7±1.2 L/min and 5.8±1.1 L/min, respectively; all P<0.001) than patients with normal LV myocardial performance. In relation to these findings, the symptomatic status (ie, New York Heart Association functional class) was significantly altered in those patients with low systolic and diastolic LV myocardial performance.
In patients with HFNEF, both systolic and diastolic LV myocardial performance are impaired, which is associated with increased LV filling pressures, decreased cardiac output, and worse New York Heart Association functional class. Therefore, the measurement of these myocardial parameters could be of great importance in HFNEF because these echocardiographic indices assess the multidirectional function of the whole myocardium of the LV, thereby allowing detection of an alteration of the global function of the LV which is associated with a worse symptomatic status in these patients.
本研究旨在通过评估左心室（LV）整体心肌的收缩和舒张功能的新型 LV 心肌指数，来研究射血分数正常的心力衰竭（HFNEF）患者的左心室收缩和舒张功能。
使用二维斑点追踪超声心动图，从 LV 节段的长轴、横轴和短轴方向评估 LV 心肌的收缩和舒张功能，分别为收缩期峰值应变和舒张早期应变率的平均值。我们研究了 HFNEF 患者和对照组，对照组由年龄、性别和 LV 射血分数相似的无症状伴 LV 舒张功能障碍患者组成。共纳入 322 例患者（92 例 HFNEF 和 230 例无症状 LV 舒张功能障碍）。HFNEF 患者的 LV 收缩和舒张功能明显低于无症状 LV 舒张功能障碍患者（分别为 20.13±6.02%和 1.14±0.27 s(-1)，25.33±6.06%和 1.37±0.33 s(-1)；均 P<0.0001）。此外，HFNEF 患者中 LV 心肌收缩和舒张功能低者的 LV 充盈压显著升高（分别为 17.1±6.6 和 17.6±6.3mmHg，12.0±5.1 和 11.7±4.7mmHg；均 P<0.001），心输出量降低（分别为 4.8±1.0 L/min 和 4.9±1.1 L/min，5.7±1.2 L/min 和 5.8±1.1 L/min；均 P<0.001），而收缩和舒张功能正常者的症状状态（即纽约心脏协会功能分级）明显改变。
HFNEF 患者的 LV 心肌收缩和舒张功能均受损，与 LV 充盈压升高、心输出量降低和纽约心脏协会功能分级恶化相关。因此，测量这些心肌参数在 HFNEF 中非常重要，因为这些超声心动图指数评估 LV 整体心肌的多向功能，从而可以检测到与这些患者症状状态恶化相关的 LV 整体功能改变。
