Batalli Arlind, Ibrahimi Pranvera, Bytyçi Ibadete, Ahmeti Artan, Haliti Edmond, Elezi Shpend, Henein Michael Y, Bajraktari Gani
Clinic of Cardiology, University Clinical Centre of Kosova, "Rrethi i Spitalit", p.n., Prishtina, Kosovo.
Medical Faculty, University of Prishtina, Prishtina, Kosovo.
Cardiovasc Ultrasound. 2017 Apr 26;15(1):12. doi: 10.1186/s12947-017-0103-x.
Quality of life is as important as survival in heart failure (HF) patients. Controversies exist with regards to echocardiographic determinants of exercise capacity in HF, particularly in patients with preserved ejection fraction (HFpEF). The aim of this study was to prospectively examine echocardiographic parameters that correlate and predict functional exercise capacity assessed by 6 min walk test (6-MWT) in patients with HFpEF.
In 111 HF patients (mean age 63 ± 10 years, 47% female), an echo-Doppler study and a 6-MWT were performed in the same day. Patients were divided into two groups based on the 6-MWT distance (Group I: ≤ 300 m and Group II: >300 m).
Group I were older (p = 0.008), had higher prevalence of diabetes (p = 0.027), higher baseline heart rate (p = 0.004), larger left atrium - LA (p = 0.001), longer LV filling time - FT (p = 0.019), shorter isovolumic relaxation time (p = 0.037), shorter pulmonary artery acceleration time - PA acceleration time (p = 0.006), lower left atrial lateral wall myocardial velocity (a') (p = 0.018) and lower septal systolic myocardial velocity (s') (p = 0.023), compared with Group II. Patients with HF and reduced EF (HFrEF) had lower hemoglobin (p = 0.007), higher baseline heart rate (p = 0.005), higher NT-ProBNP (p = 0.001), larger LA (p = 0.004), lower septal s', e', a' waves, and septal mitral annular plane systolic excursion (MAPSE), shorter PA acceleration time (p < 0.001 for all), lower lateral MAPSE, higher E/A & E/e', and shorter LVFT (p = 0.001 for all), lower lateral e' (p = 0.009), s' (p = 0.006), right ventricular e' and LA emptying fraction (p = 0.012 for both), compared with HFpEF patients. In multivariate analysis, only LA diameter [2.676 (1.242-5.766), p = 0.012], and diabetes [0.274 (0.084-0.898), p = 0.033] independently predicted poor 6-MWT performance in the group as a whole. In HFrEF, age [1.073 (1.012-1.137), p = 0.018] and LA diameter [3.685 (1.348-10.071), p = 0.011], but in HFpEF, lateral s' [0.295 (0.099-0.882), p = 0.029], and hemoglobin level [0.497 (0.248-0.998), p = 0.049] independently predicted poor 6-MWT performance.
In HF patients determinants of exercise capacity differ according to severity of overall LV systolic function, with left atrial enlargement in HFrEF and longitudinal systolic shortening in HFpEF as the the main determinants.
生活质量对于心力衰竭（HF）患者而言与生存同样重要。关于HF患者运动能力的超声心动图决定因素存在争议，尤其是在射血分数保留的患者（HFpEF）中。本研究的目的是前瞻性地研究与HFpEF患者通过6分钟步行试验（6-MWT）评估的功能性运动能力相关并可预测该能力的超声心动图参数。
对111例HF患者（平均年龄63±10岁，47%为女性）在同一天进行了超声多普勒研究和6-MWT。根据6-MWT距离将患者分为两组（I组：≤300米和II组：>300米）。
与II组相比，I组年龄更大（p = 0.008），糖尿病患病率更高（p = 0.027），基线心率更高（p = 0.004），左心房（LA）更大（p = 0.001），左心室充盈时间（FT）更长（p = 0.019），等容舒张时间更短（p = 0.037），肺动脉加速时间（PA加速时间）更短（p = 0.006），左心房侧壁心肌速度（a'）更低（p = 0.018），室间隔收缩期心肌速度（s'）更低（p = 0.023）。与HFpEF患者相比，射血分数降低的心力衰竭（HFrEF）患者血红蛋白水平更低（p = 0.007），基线心率更高（p = 0.005），N末端脑钠肽前体（NT-ProBNP）更高（p = 0.001），LA更大（p = 0.004），室间隔s'、e'、a'波以及室间隔二尖瓣环平面收缩期位移（MAPSE）更低，PA加速时间更短（所有p < 0.001），侧壁MAPSE更低，E/A和E/e'更高，LVFT更短（所有p = 0.001），侧壁e'更低（p = 0.009），s'更低（p = 0.006），右心室e'和LA排空分数更低（两者p = 0.012）。在多变量分析中，仅LA直径[2.676（1.242 - 5.766），p = 0.012]和糖尿病[0.274（0.084 - 0.898），p = 0.033]可独立预测整个组中6-MWT表现不佳。在HFrEF中，年龄[1.073（1.012 - 1.137），p = 0.018]和LA直径[3.685（1.348 - 10.071），p = 0.011]可独立预测6-MWT表现不佳，但在HFpEF中，侧壁s'[0.295（0.099 - 0.882），p = 0.029]和血红蛋白水平[0.497（0.248 - 0.998），p = 0.049]可独立预测6-MWT表现不佳。
在HF患者中，运动能力的决定因素因左心室整体收缩功能的严重程度而异，HFrEF中主要决定因素是左心房扩大，而HFpEF中是纵向收缩缩短。
