Division of Molecular and Clinical Medicine, University of Dundee, Dundee, United Kingdom.
School of Medicine and Dentistry, University of Aberdeen, Aberdeen, United Kingdom.
JACC Cardiovasc Imaging. 2018 Apr;11(4):577-585. doi: 10.1016/j.jcmg.2017.05.022. Epub 2017 Aug 16.
The aim of this study was to investigate the utility of a comprehensive imaging protocol including echocardiography and cardiac magnetic resonance in the diagnosis and differentiation of hypertensive heart disease and heart failure with preserved ejection fraction (HFpEF).
Hypertension is present in up to 90% of patients with HFpEF and is a major etiological component. Despite current recommendations and diagnostic criteria for HFpEF, no noninvasive imaging technique has as yet shown the ability to identify any structural differences between patients with hypertensive heart disease and HFpEF.
We conducted a prospective cross-sectional study of 112 well-characterized patients (62 with HFpEF, 22 with hypertension, and 28 healthy control subjects). All patients underwent cardiopulmonary exercise and biomarker testing and an imaging protocol including echocardiography with speckle-tracking analysis and cardiac magnetic resonance including T mapping pre- and post-contrast.
Echocardiographic global longitudinal strain (GLS) and extracellular volume (ECV) measured by cardiac magnetic resonance were the only variables able to independently stratify among the 3 groups of patients. ECV was the best technique for differentiation between hypertensive heart disease and HFpEF (ECV area under the curve: 0.88; GLS area under the curve: 0.78; p < 0.001 for both). Using ECV, an optimal cutoff of 31.2% gave 100% sensitivity and 75% specificity. ECV was significantly higher and GLS was significantly reduced in subjects with reduced exercise capacity (lower peak oxygen consumption and higher minute ventilation-carbon dioxide production) (p < 0.001 for both ECV and GLS).
Both GLS and ECV are able to independently discriminate between hypertensive heart disease and HFpEF and identify patients with prognostically significant functional limitation. ECV is the best diagnostic discriminatory marker of HFpEF and could be used as a surrogate endpoint for therapeutic studies.
本研究旨在探讨包括超声心动图和心脏磁共振成像在内的综合成像方案在诊断和鉴别高血压性心脏病和射血分数保留心力衰竭（HFpEF）中的应用价值。
HFpEF 患者中高达 90%存在高血压，且高血压是主要的病因组成部分。尽管目前有 HFpEF 的推荐诊断标准，但尚无任何非侵入性成像技术能够确定高血压性心脏病和 HFpEF 患者之间的任何结构差异。
我们对 112 例特征明确的患者（HFpEF 患者 62 例、高血压患者 22 例和健康对照组 28 例）进行了前瞻性横断面研究。所有患者均接受心肺运动和生物标志物检测，并进行包括斑点追踪分析的超声心动图和包括对比前和对比后 T 映射的心脏磁共振成像。
超声心动图整体纵向应变（GLS）和心脏磁共振测量的细胞外容积（ECV）是能够独立分层的 3 组患者的唯一变量。ECV 是区分高血压性心脏病和 HFpEF 的最佳技术（ECV 曲线下面积：0.88；GLS 曲线下面积：0.78；均 p < 0.001）。使用 ECV，最佳截断值为 31.2%，敏感性为 100%，特异性为 75%。ECV 显著升高，GLS 显著降低，与运动能力降低（较低的峰值耗氧量和较高的分钟通气量-二氧化碳产量）的患者相关（ECV 和 GLS 均 p < 0.001）。
GLS 和 ECV 均能独立区分高血压性心脏病和 HFpEF，并识别具有预后意义的功能受限患者。ECV 是 HFpEF 最佳的诊断区分标志物，可作为治疗研究的替代终点。
