Toufan Mehrnoush, Mohammadzadeh Gharebaghi Saeed, Pourafkari Leili, Delir Abdolahinia Elham
Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
Bone Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
J Tehran Heart Cent. 2015 Oct 27;10(4):194-200.
Echocardiographic evaluations of the longitudinal axis of the left ventricular (LV) function have been used in the diagnosis and assessment of heart failure with normal ejection fraction (HFNEF). The evaluation of the global and segmental peak systolic longitudinal strains (PSLSs) by two-dimensional speckle tracking echocardiography (STE) may correlate with conventional echocardiography findings. We aimed to use STE to evaluate the longitudinal function of the LV in patients with HFNEF.
In this study, 126 patients with HFNEF and diastolic dysfunction and 60 normal subjects on conventional echocardiography underwent STE evaluations, including LV end-diastolic and end-systolic dimensions; interventricular septal thickness; posterior wall thickness; LV volume; LV ejection fraction; left atrial volume index; early diastolic peak flow velocity (𝐸); late diastolic peak flow velocity (𝐴); 𝐸/𝐴 ratio; deceleration time of 𝐸; early diastolic myocardial velocity (e'); late diastolic myocardial velocity (A'); systolic myocardial velocity (S); and global, basal, mid, and apical PSLSs. The correlations between these methods were assessed.
The mean age was 57.50 ± 10.07 years in the HFNEF patients and 54.90 ± 7.17 years in the control group. The HFNEF group comprised 69.8% males and 30.2% females, and the normal group consisted of 70% males and 30% females. The global, basal, mid, and apical PSLSs were significantly lower in the HFNEF group (p value < 0.001 for all). There was a significant positive correlation between the global PSLS and the septal e' (p value < 0.001). There was a negative correlation between the global PSLS and the E/e' ratio (p value = 0.001). There was a significant negative correlation between the E/e' ratio and the mid PSLS (p value = 0.002) and the basal PSLS (p value = 0.001). There was a weak positive correlation between the septal e' and the mid PSLS (p value = 0.001) and the basal PSLS (p value < 0.001). There were also weak negative correlations between the isovolumic relaxation time and the global PSLS (p value = 0.022) and the mid PSLS (p value = 0.018) and also between the New York Heart Association functional class and the mid PSLS (p value = 0.041) and the basal PSLS (p value = 0.009).
Our HFNEF patients on conventional echocardiography had different STE findings compared to our normal subjects, which is indicative of diastolic dysfunction. The longitudinal systolic function of the LV, which was measured by STE, was reduced in all the segments, denoting some degree of subclinical systolic dysfunction in these patients.
左心室（LV）功能纵向轴的超声心动图评估已用于射血分数正常的心力衰竭（HFNEF）的诊断和评估。二维斑点追踪超声心动图（STE）对整体和节段性收缩期纵向峰值应变（PSLS）的评估可能与传统超声心动图结果相关。我们旨在使用STE评估HFNEF患者的左心室纵向功能。
在本研究中，126例HFNEF和舒张功能障碍患者以及60例常规超声心动图检查正常的受试者接受了STE评估，包括左心室舒张末期和收缩末期内径；室间隔厚度；后壁厚度；左心室容积；左心室射血分数；左心房容积指数；舒张早期峰值流速（E）；舒张晚期峰值流速（A）；E/A比值；E的减速时间；舒张早期心肌速度（e'）；舒张晚期心肌速度（A'）；收缩期心肌速度（S）；以及整体、基底、中间和心尖PSLS。评估了这些方法之间的相关性。
HFNEF患者的平均年龄为57.50±10.07岁，对照组为54.90±7.17岁。HFNEF组男性占69.8%，女性占30.2%，正常组男性占70%，女性占30%。HFNEF组的整体、基底、中间和心尖PSLS均显著降低（所有p值<0.001）。整体PSLS与室间隔e'之间存在显著正相关（p值<0.001）。整体PSLS与E/e'比值之间存在负相关（p值=0.001）。E/e'比值与中间PSLS（p值=0.002）和基底PSLS（p值=0.001）之间存在显著负相关。室间隔e'与中间PSLS（p值=0.001）和基底PSLS（p值<0.001）之间存在弱正相关。等容舒张时间与整体PSLS（p值=0.022）和中间PSLS（p值=0.018）之间以及纽约心脏协会功能分级与中间PSLS（p值=0.041）和基底PSLS（p值=0.009）之间也存在弱负相关。
与正常受试者相比，我们的HFNEF患者在常规超声心动图检查中有不同的STE表现，这表明存在舒张功能障碍。通过STE测量的左心室纵向收缩功能在所有节段均降低，表明这些患者存在一定程度的亚临床收缩功能障碍。
