Kattel Sharma, Memon Salim, Saito Keiko, Narula Jagat, Saito Yuji
Department of Medicine, Sisters of Charity Hospital, University at Buffalo, Buffalo, NY, USA; Division of Hospital Medicine, Mayo Clinic Health System, Albert Lea/Austin, MN, USA.
Department of Medicine, Sisters of Charity Hospital, University at Buffalo, Buffalo, NY, USA.
Hellenic J Cardiol. 2016 Mar-Apr;57(2):92-8. doi: 10.1016/j.hjc.2016.03.004. Epub 2016 Apr 5.
Left ventricular diastolic dysfunction (LVDD) is associated with a variety of medical conditions. Left ventricular hypertrophy (LVH) is one of the most common abnormalities that induce LVDD. However, it is unclear whether LVH is a predictor of future LVDD deterioration that leads to diastolic heart failure in patients who already have mild-to-moderate LVDD. In this study, we investigated the effect of LVH on LV diastolic function in mild-to-moderate LVDD patients.
Of the patients with mild-to-moderate LVDD (Grade I and II) with preserved left ventricular ejection fraction (EF), 225 with LVH (LVH group) and 225 without LVH (non-LVH group) were consecutively selected. LVDD was defined by the abnormal patterns of Doppler mitral inflow and tissue Doppler. Left ventricular filling pressure (FP) was estimated by the following formula: 1.9 +1.24× [early mitral inflow velocity (E)/early mitral annular velocity (e')]. The Tei index was implemented to assess global (both systolic and diastolic) left ventricular function. Echocardiographic parameters for LVDD, such as isovolumic relaxation time (IVRT), were compared between the two groups.
FP and Tei index were significantly higher in the LVH group compared to the non-LVH group [15.68 mmHg vs. 14.07 mmHg, P < 0.0001, and 0.58 vs. 0.53, P < 0.003, respectively]. IVRT was significantly longer in the LVH group than in the non-LVH group [103.93 ± 23.93 vs. 95.94 ± 20.16, P < 0.0001].
In mild-to-moderate LVDD patients, both FP and the Tei index were significantly higher when LVH was present. This may suggest LVH as a possible predictor for the future development of severe LVDD and diastolic heart failure.
左心室舒张功能障碍（LVDD）与多种医学状况相关。左心室肥厚（LVH）是诱发LVDD最常见的异常情况之一。然而，对于已经患有轻度至中度LVDD的患者，LVH是否是未来LVDD恶化导致舒张性心力衰竭的预测指标尚不清楚。在本研究中，我们调查了LVH对轻度至中度LVDD患者左心室舒张功能的影响。
连续选取225例左心室射血分数（EF）保留的轻度至中度LVDD（I级和II级）患者，其中225例有LVH（LVH组），225例无LVH（非LVH组）。LVDD通过二尖瓣血流多普勒和组织多普勒的异常模式定义。左心室充盈压（FP）通过以下公式估算：1.9 + 1.24×[二尖瓣早期血流速度（E）/二尖瓣环早期速度（e'）]。采用Tei指数评估左心室整体（收缩期和舒张期）功能。比较两组之间LVDD的超声心动图参数，如等容舒张时间（IVRT）。
LVH组的FP和Tei指数显著高于非LVH组[分别为15.68 mmHg对14.07 mmHg，P < 0.0001；0.58对0.53，P < 0.003]。LVH组的IVRT显著长于非LVH组[103.93±23.93对95.94±20.16，P < 0.0001]。
在轻度至中度LVDD患者中，存在LVH时FP和Tei指数均显著升高。这可能表明LVH是严重LVDD和舒张性心力衰竭未来发展的一个可能预测指标。
