Lüers Claus, Trippel Tobias Daniel, Seeländer Sebastian, Wachter Rolf, Hasenfuss Gerd, Lindhorst Ruhdja, Bobenko Anna, Nolte Kathleen, Pieske Burkert, Edelmann Frank
Department of Cardiology, European Medical School, University of Oldenburg, Oldenburg, Germany.
Department of Cardiology, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin, Berlin, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.
J Am Soc Hypertens. 2017 May;11(5):303-313. doi: 10.1016/j.jash.2017.03.006. Epub 2017 Mar 27.
Left ventricular filling pressure (LVFP) is a marker for diastolic dysfunction and heart failure (HF) with preserved ejection fraction (pEF). The interaction between arterial stiffness (AS) and elevated LVFP has not been sufficiently investigated. In 257 patients with preserved left ventricular ejection fraction (mean age: 66 years, 53% female, mean left ventricular ejection fraction: 61%) and at least one cardiovascular risk factor (eg, hypertension and diabetes) for the development of HF or a previous diagnosis of HF, LVFP was estimated in accordance with the recommendations of the American Society of Echocardiography (elevated when E/e' ≥ 13, left atrial volume index ≥ 34 mL/m). LVFP was correlated with radial pulse wave analysis (augmentation index normalized by 75 b/min [AIx@75]) and carotid-femoral pulse wave velocity (cfPWV). Thirty-eight percent of patients demonstrated an elevated LVFP. These patients were significantly older (68.3 ± 7.4 vs. 63.5 ± 7.6 years, P < .001), demonstrated a higher body mass index (29.8 ± 4.6 vs. 28.0 ± 5.0; P < .01), presented more often with hypertension (89.7% vs. 73.1%, P < .01), hypercholesterolemia (32.0% vs. 21.3%, P < .05), dyspnea on exertion (28.4% vs. 16.6%, P < .05), and peripheral edema (25.3% vs. 10.2%, P < .01). cfPWV and AIx@75 and were significantly elevated in patients with elevated LVFP (12.2 ± 2.7 m/s vs. 10.5 ± 2.6 m/s, P < .001, an 29.2 ± 6.7% vs. 27.4 ± 6.7%, P < .05 respectively). cfPWV and AIx@75 were correlated with echocardiographic parameters, that is, posterior wall thickness (r = 0.292, P < .001; r = 0.167, P < .01), left ventricular mass index (r = 0.255, P < .001; r = -0.192, P < .01), e' (r = -0.508, P < .001; r = -0.159, P < .05), and E/e' (r = 0.380, P < .001; r = 0.200, P < .01). cfPWV correlated with left atrial volume index (r = 0.189, P < .05) and increasing E/A ratio (r = -0.334, P < .001). Multivariate linear regression analysis demonstrated age and PWV as most important and independent predictors of LVFP elevation in the cohort. Increased AS measured by cfPWV was associated with an elevated LVFP in patients with preserved systolic function. Whether targeting AS as a major component of diastolic dysfunction and HF with preserved ejection fraction needs to be further investigated.
左心室充盈压（LVFP）是舒张功能障碍和射血分数保留的心力衰竭（HFpEF）的一个标志物。动脉僵硬度（AS）与升高的LVFP之间的相互作用尚未得到充分研究。在257例左心室射血分数保留的患者（平均年龄：66岁，53%为女性，平均左心室射血分数：61%）中，这些患者至少有一项发生HF的心血管危险因素（如高血压和糖尿病）或既往有HF诊断，根据美国超声心动图学会的建议评估LVFP（当E/e'≥13、左心房容积指数≥34 mL/m²时升高）。LVFP与桡动脉脉搏波分析（以75次/分钟标准化的增强指数[AIx@75]）和颈股脉搏波速度（cfPWV）相关。38%的患者LVFP升高。这些患者年龄显著更大（68.3±7.4岁对63.5±7.6岁，P<.001），体重指数更高（29.8±4.6对28.0±5.0；P<.01），更常出现高血压（89.7%对73.1%，P<.01）、高胆固醇血症（32.0%对21.3%，P<.05）、劳力性呼吸困难（28.4%对16.6%，P<.05）和外周水肿（25.3%对10.2%，P<.01）。LVFP升高的患者cfPWV和AIx@75显著升高（分别为12.2±2.7 m/s对10.5±2.6 m/s，P<.001；以及29.2±6.7%对27.4±6.7%，P<.05）。cfPWV和AIx@75与超声心动图参数相关，即后壁厚度（r=0.292，P<.001；r=0.167，P<.01）、左心室质量指数（r=0.255, P<.001；r=-0.192，P<.01）、e'（r=-0.508，P<.001；r=-0.159，P<.05）和E/e'（r=0.380，P<.001；r=0.200，P<.01）。cfPWV与左心房容积指数（r=0.189，P<.05）和升高的E/A比值（r=-0.334，P<.001）相关。多变量线性回归分析表明，年龄和PWV是该队列中LVFP升高最重要且独立的预测因素。在收缩功能保留的患者中，通过cfPWV测量的AS增加与LVFP升高相关。是否将AS作为舒张功能障碍和射血分数保留的HF的主要组成部分进行靶向治疗有待进一步研究。
