Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi.
Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi.
J Card Fail. 2017 Aug;23(8):581-588. doi: 10.1016/j.cardfail.2017.05.002. Epub 2017 May 8.
Clinical risk factors associated with heart failure (HF) symptoms in aortic stenosis (AS) patients with preserved ejection fraction (EF) have not been fully identified. We hypothesized that left ventricular (LV) diastolic stiffness is associated with HF symptoms in patients with AS.
We retrospectively evaluated 275 patients with at least moderate AS (aortic valve area <1.5 cm) and preserved EF (≥50%). LV diastolic stiffness was evaluated with the use of echocardiographic parameters, diastolic wall strain (DWS, a measure of LV wall stiffness), and K (a marker of LV chamber stiffness). There were 69 patients with HF. Patients with HF were older, were more likely to be African American, had a higher body mass index, and had more hypertension and coronary artery disease (P < .05 for all). Aortic valve area index and mean pressure gradient across the aortic valve were not different between patients with and without HF. Despite similar echocardiographic parameters of AS severity, patients with HF had stiffer LV (DWS 0.21 ± 0.06 vs 0.25 ± 0.06 [P < .01], K 0.17 ± 0.11 vs 0.13 ± 0.08 [P < .01]). Logistic regression analyses revealed that after adjusting for age, race, body mass index, history of hypertension, and coronary artery disease, LV diastolic stiffness parameters remained significantly associated with HF symptoms.
LV diastolic stiffness is independently associated with HF in AS patients with preserved EF.
射血分数保留的主动脉瓣狭窄（AS）患者与心力衰竭（HF）症状相关的临床危险因素尚未完全明确。我们假设左心室（LV）舒张僵硬与 AS 患者的 HF 症状相关。
我们回顾性评估了 275 名至少中度 AS（主动脉瓣面积 <1.5 cm）和射血分数保留（≥50%）的患者。使用超声心动图参数、舒张壁应变（DWS，LV 壁僵硬的指标）和 K（LV 腔僵硬的指标）评估 LV 舒张僵硬。共有 69 名 HF 患者。HF 患者年龄较大，更可能为非裔美国人，体重指数更高，且高血压和冠心病的发病率更高（所有 P <.05）。HF 患者和无 HF 患者的主动脉瓣面积指数和跨主动脉瓣平均压力梯度无差异。尽管 AS 严重程度的超声心动图参数相似，但 HF 患者的 LV 更僵硬（DWS 0.21 ± 0.06 比 0.25 ± 0.06 [P <.01]，K 0.17 ± 0.11 比 0.13 ± 0.08 [P <.01]）。Logistic 回归分析显示，在校正年龄、种族、体重指数、高血压病史和冠心病后，LV 舒张僵硬参数与 HF 症状仍显著相关。
LV 舒张僵硬与射血分数保留的 AS 患者 HF 独立相关。
