a Division of Cardiology, Department of Internal Medicine , Mackay Memorial Hospital , Taipei , Taiwan.
b Department of Medicine , Mackay Medical College, and Mackay Medicine Nursing and Management College , Taipei , Taiwan.
Clin Exp Hypertens. 2017;39(5):473-480. doi: 10.1080/10641963.2016.1273947. Epub 2017 Jun 1.
The associations among chronic health conditions, ventricular geometric alterations or cardiac contractile mechanics in different phenotypes heart failure (HF) remain largely unexplored.
We studied 438 consecutive hospitalized patients (mean age: 64.9 ± 16.6 years, 52.5% female) with or without clinical evidence of HF. We examined the associations among clinical co-morbidities, LV geometries and systolic mechanics in terms of global myocardial strains.
Increasing clinical co-morbidities was associated with greater LV mass, worse longitudinal deformations and higher proportion of admission with HF diagnosis, which was more pronounced in HFpEF (from 6.4% to 40.7%, X < 0.001). The independent association between co-morbidity burden and longitudinal functional decay remained unchanged after adjusting for age and sex for all admissions and in HFpEF (Coef: 0.82 & 0.71, SE: 0.13 & 0.21, both p≤0.001). By using co-morbidity scores, the area under receiver operating characteristic curves (AUROC) in identifying HFpEF was 0.71 (95% CI: 0.65 to 0.77), 0.64 (95% CI: 0.58 to 0.71) for HFrEF and 0.72 for both (95% CI: 0.67 to 0.77). Co-morbidity burden superimposed on LV mass index and LV filling pressure (E/E') further expanded the AUROC significantly in diagnosing both types HF (c-statistics from 0.73 to 0.81, p for ΔAUROC: 0.0012).
Chronic health conditions in the admission population were associated with unfavorable cardiac remodeling, impair cardiac contractile mechanics and further added significantly incremental value in HF diagnosis. Our data suggested the potentiality for better cardiac function by controlling baseline co-morbidities in hospitalized HF patients, especially HFpEF.
CAD: coronary artery disease; CKD: chronic kidney disease; DT: deceleration time; eGFR: Estimated glomerular filtration rate; HF: heart failure; IVRT: iso-volumic relaxation time; LV: left ventricular; LVEF: left ventricular ejection fraction; RWT: relative wall thickness; TDI: Tissue Doppler imaging.
慢性健康状况、心室几何变化或不同表型心力衰竭（HF）的心脏收缩力学之间的关系在很大程度上仍未得到探索。
我们研究了 438 例连续住院的患者（平均年龄：64.9±16.6 岁，52.5%为女性），他们有或没有心力衰竭的临床证据。我们根据整体心肌应变，研究了临床合并症、LV 几何形状和收缩力学之间的关系。
临床合并症的增加与 LV 质量增加、纵向变形恶化以及因心力衰竭入院的比例增加有关，HFpEF 中更为明显（从 6.4%增加到 40.7%，X<0.001）。在所有入院患者和 HFpEF 患者中，调整年龄和性别后，合并症负担与纵向功能衰减的独立相关性保持不变（Coef：0.82&0.71，SE：0.13&0.21，均 P≤0.001）。使用合并症评分，识别 HFpEF 的受试者工作特征曲线（AUROC）下面积为 0.71（95%CI：0.65 至 0.77）、0.64（95%CI：0.58 至 0.71）、HFrEF 为 0.72（95%CI：0.67 至 0.77）。LV 质量指数和 LV 充盈压（E/E'）上叠加的合并症负担显著扩大了两种类型 HF 的 AUROC（c 统计量从 0.73 增加到 0.81，P 值为ΔAUROC：0.0012）。
入院人群中的慢性健康状况与不利的心脏重塑、心脏收缩力学受损有关，并进一步在心力衰竭诊断中提供了显著的增量价值。我们的数据表明，通过控制住院心力衰竭患者的基线合并症，可能会改善心脏功能，尤其是 HFpEF。
CAD：冠状动脉疾病；CKD：慢性肾脏疾病；DT：减速时间；eGFR：估算肾小球滤过率；HF：心力衰竭；IVRT：等容松弛时间；LV：左心室；LVEF：左心室射血分数；RWT：相对壁厚度；TDI：组织多普勒成像。
