Iwano Hiroyuki, Kamimura Daisuke, Fox Ervin R, Hall Michael E, Vlachos Pavlos, Little William C
Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan; Division of Cardiology, University of Mississippi Medical Center, Jackson, Mississippi.
Division of Cardiology, University of Mississippi Medical Center, Jackson, Mississippi.
J Card Fail. 2016 Dec;22(12):945-953. doi: 10.1016/j.cardfail.2016.04.007. Epub 2016 Apr 14.
Early-diastolic left ventricular (LV) longitudinal expansion is delayed with diastolic dysfunction. We hypothesized that, in patients with heart failure (HF), regardless of LV ejection fraction (EF), there is diastolic temporal nonuniformity with a delay of longitudinal relative to circumferential expansion.
Echocardiography was performed in 143 HF patients-50 with preserved EF (HFpEF) and 93 with reduced EF (HFrEF)-as well as 31 normal control subjects. The delay of early-diastolic mitral annular velocity from the mitral Doppler E (T) was measured as a parameter of the longitudinal expansion delay. The delay of the longitudinal early-diastolic global strain rate (SR) relative to circumferential SR (Delay) was calculated as a parameter of temporal nonuniformity. Intra-LV pressure difference (IVPD) was estimated with the use of color M-mode Doppler data as a parameter of LV diastolic suction. Although normal control subjects had symmetric LV expansion in early diastole, T and Delay were significantly prolonged in HF regardless of EF (P < .01 vs control for all). Multivariate analysis revealed that Delay was the independent determinant of IVPD among the parameters of LV geometry and contraction (β = -0.21; P < .05).
An abnormal temporal nonuniformity of early-diastolic expansion is present in HF regardless of EF, which was associated with reduced LV suction.
舒张功能障碍时舒张早期左心室（LV）纵向扩张延迟。我们假设，在心力衰竭（HF）患者中，无论左心室射血分数（EF）如何，舒张期均存在时间上的不均匀性，纵向扩张相对于周向扩张延迟。
对143例HF患者（50例EF保留的HF患者[HFpEF]和93例EF降低的HF患者[HFrEF]）以及31名正常对照者进行了超声心动图检查。测量二尖瓣多普勒E波（T）得出的舒张早期二尖瓣环速度延迟，作为纵向扩张延迟的参数。计算纵向舒张早期整体应变率（SR）相对于周向SR的延迟（延迟时间），作为时间不均匀性的参数。使用彩色M型多普勒数据估计左心室内压差（IVPD），作为左心室舒张期抽吸的参数。尽管正常对照者在舒张早期左心室扩张对称，但无论EF如何，HF患者的T和延迟时间均显著延长（与对照组相比，P均<0.01）。多变量分析显示，在左心室几何形状和收缩参数中，延迟时间是IVPD的独立决定因素（β=-0.21；P<0.05）。
无论EF如何，HF患者舒张早期扩张均存在异常的时间不均匀性，这与左心室抽吸减少有关。
