Pratap Balaji, Kallur Kamala Ramya, Argulian Edgar
Mt Sinai St. Luke's Hospital, New York, NY, USA.
Echocardiography. 2017 Jun;34(6):825-830. doi: 10.1111/echo.13532. Epub 2017 Apr 1.
Impaired relaxation filling pattern in the presence of preserved left ventricular ejection fraction is a common finding which is ascribed to early diastolic dysfunction. We thought to determine the distribution of various markers of systolic and diastolic dysfunction in these patients.
A total of 106 patients were included in this retrospective observational study. Diastolic dysfunction was defined using the American Society of Echocardiography recommendations ("50% rule"). The systolic dysfunction was evaluated by global longitudinal strain and circumferential strain. For further analysis, the patients were divided into the lower strain (lower tertile) and higher strain (upper tertiles) groups based on longitudinal strain.
There were marked differences between the groups in essential echocardiographic parameters. Patients in the lower strain group were more likely to have definite diastolic dysfunction (23% vs 7%, P<.01) and less likely to have normal diastolic function (54% vs 80%, P<.01). They also showed lower circumferential strain (-21.2% vs -25.7%, P<.01). In multivariate analysis, left atrial enlargement (odds ratio (OR) 4.6, 95% confidence interval (CI) 1.2-17.1), left ventricular mass index (OR 1.03, 95% CI 1.0-1.1), left ventricular end-diastolic volume (OR 1.1, 95% CI 1.0-1.1), and E-wave deceleration time (OR 0.99, 95% CI 0.98-1.0) were independently associated with lower global longitudinal strain.
Patients with impaired relaxation filling pattern in the presence of preserved left ventricular ejection fraction have a wide spectrum of left ventricular systolic and diastolic performance abnormalities. Isolated assessment of diastolic dysfunction may not fully characterize this group of patients.
在左心室射血分数保留的情况下出现舒张期充盈模式受损是一种常见现象，这归因于早期舒张功能障碍。我们旨在确定这些患者中收缩和舒张功能障碍的各种标志物的分布情况。
本回顾性观察研究共纳入106例患者。舒张功能障碍采用美国超声心动图学会的推荐标准（“50%规则”）进行定义。收缩功能障碍通过整体纵向应变和圆周应变进行评估。为进一步分析，根据纵向应变将患者分为低应变组（下三分位数）和高应变组（上三分位数）。
两组在基本超声心动图参数上存在显著差异。低应变组患者更有可能出现明确的舒张功能障碍（23%对7%，P<0.01），而舒张功能正常的可能性较小（54%对80%，P<0.01）。他们还表现出较低的圆周应变（-21.2%对-25.7%，P<0.01）。在多变量分析中，左心房扩大（比值比（OR）4.6，95%置信区间（CI）1.2-17.1）、左心室质量指数（OR 1.03，95%CI 1.0-1.1）、左心室舒张末期容积（OR 1.1，95%CI 1.0-1.1）和E波减速时间（OR 0.99，95%CI 0.98-1.0）与较低的整体纵向应变独立相关。
在左心室射血分数保留的情况下出现舒张期充盈模式受损的患者存在广泛的左心室收缩和舒张功能异常。单独评估舒张功能障碍可能无法完全描述这组患者的特征。
