Issa Omar, Peguero Julio G, Podesta Carlos, Diaz Denisse, De La Cruz Javier, Pirela Daniela, Brenes Juan Carlos
Columbia University Division of Cardiology, Mount Sinai Medical Center, Miami Beach, FL, USA.
Department of Internal Medicine, Mount Sinai Medical Center, Miami Beach, FL, USA.
J Cardiovasc Echogr. 2017 Jan-Mar;27(1):1-6. doi: 10.4103/2211-4122.199064.
Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome associated with diastolic function abnormalities. It remains unclear which factors, if any, can predict the transition from asymptomatic diastolic dysfunction to an overt symptomatic phase.
Patients hospitalized with suspected heart failure between January 2012 and November 2014 with a transthoracic echocardiogram demonstrating preserved systolic function were screened ( = 425). Patients meeting the American College of Cardiology Foundation/American Heart Association definition for HFpEF ( = 40) were matched in a 1:1 fashion to individuals admitted for hypertensive urgency with diastolic dysfunction and neither pulmonary edema nor history of heart failure ( = 40). The clinical records and echocardiograms of all eighty patients included in this retrospective study were reviewed.
Patients with HFpEF had higher body mass index (BMI), creatinine, beta-blocker use, and Grade 2 diastolic dysfunction when compared to the hypertensive control population. Echocardiographic analysis demonstrated higher right ventricular systolic pressures, left ventricular mass index, E/A, and E/e' in patients with HFpEF. Similarly, differences were observed in most left atrial (LA) parameters including larger LA maximum and minimum volume indices, as well as smaller LA-emptying fractions in the heart failure group. Multivariate logistic regression analysis revealed LA minimum volume index (odds ratio [OR]: 1.23 [1.09-1.38], = 0.001) to have the strongest association with heart failure hospitalization after adjustment for creatinine (OR: 7.09 [1.43-35.07], = 0.016) and BMI (OR: 1.11 [0.99-1.25], = 0.074).
LA minimum volume index best correlated with HFpEF in this patient cohort with diastolic dysfunction.
射血分数保留的心力衰竭（HFpEF）是一种与舒张功能异常相关的临床综合征。目前尚不清楚哪些因素（如果有的话）能够预测从无症状舒张功能障碍转变为明显的症状阶段。
对2012年1月至2014年11月因疑似心力衰竭住院且经胸超声心动图显示收缩功能保留的患者进行筛查（n = 425）。符合美国心脏病学会基金会/美国心脏协会HFpEF定义的患者（n = 40）与因高血压急症伴舒张功能障碍入院且无肺水肿或心力衰竭病史的个体以1:1的方式进行匹配（n = 40）。对这项回顾性研究纳入的所有80例患者的临床记录和超声心动图进行了审查。
与高血压对照组相比，HFpEF患者的体重指数（BMI）、肌酐、β受体阻滞剂使用情况及2级舒张功能障碍发生率更高。超声心动图分析显示，HFpEF患者的右心室收缩压、左心室质量指数、E/A及E/e'更高。同样，在大多数左心房（LA）参数方面也观察到差异，包括心力衰竭组中更大的左心房最大和最小容积指数，以及更小的左心房排空分数。多因素逻辑回归分析显示，在对肌酐（比值比[OR]：7.09 [1.43 - 35.07]，P = 0.016）和BMI（OR：1.11 [0.99 - 1.25]，P = 0.074）进行校正后，左心房最小容积指数（OR：1.23 [1.09 - 1.38]，P = 0.001）与心力衰竭住院的相关性最强。
在这个舒张功能障碍患者队列中，左心房最小容积指数与HFpEF的相关性最佳。
