From the Department of Internal Medicine/Cardiology, Heart Center, Leipzig University, Germany (K.-P.R., M.v.R., C.O., K.L., C.B., S.B., K.F., M.S., G.S., H.T., P.L.); Medical Clinic II (Cardiology, Angiology, Intensive Care Medicine), University Heart Center Luebeck, Germany (T.S.); and Heart Center Dresden, University Hospital at the Technical University Dresden, Germany (V.A., A.L.).
Circ Heart Fail. 2018 Feb;11(2):e004121. doi: 10.1161/CIRCHEARTFAILURE.117.004121.
Although systolic right ventricular (RV) dysfunction has been shown to be a potent predictor for adverse outcomes in patients with heart failure with preserved ejection fraction (HFpEF), RV functional abnormalities in the course of the syndrome are not well characterized. We, therefore, sought to assess load-independent and load-dependent systolic and diastolic characteristics of RV function in stable outpatients with HFpEF.
We invasively obtained RV and left ventricular pressure-volume loops in 24 HFpEF patients and 9 patients without heart failure symptoms with a conductance catheter during basal conditions and handgrip exercise. Transient preload reduction was used to extrapolate the RV end-systolic elastance and diastolic stiffness constant. HFpEF patients and controls showed similar left ventricular and RV dimensions and ejection fractions with elevated left ventricular filling pressures. In HFpEF patients, invasively determined load-independent RV contractility (=0.04) and load-independent passive RV stiffness constant β (<0.01) were elevated. Although RV relaxation and cardiac output were similar at baseline, HFpEF patients demonstrated a blunted increase in cardiac output under exercise (=0.01) associated with prolonged RV relaxation (=0.01), decrease in stroke volume (<0.01), higher RV-filling pressures (<0.01), and a marked increase in the end-diastolic pressure-volume relationship (<0.01).
In compensated stages of the HFpEF syndrome, systolic RV function is preserved, but diastolic abnormalities with intrinsic RV stiffness and prolonged RV relaxation are already present. Impaired diastolic RV reserve contributes to a blunted increase in cardiac output during exertion. Because impairments in diastolic function seem to be a biventricular phenomenon, RV diastolic dysfunction warrants further consideration when characterizing HFpEF patients.
https://www.clinicaltrials.gov. Unique identifier: NCT02459626.
虽然收缩期右心室（RV）功能障碍已被证明是射血分数保留型心力衰竭（HFpEF）患者不良预后的有力预测指标，但该综合征过程中的 RV 功能异常尚不清楚。因此，我们试图评估稳定的 HFpEF 门诊患者 RV 收缩和舒张功能的负荷独立和负荷依赖特征。
我们使用心导管在基础状态和握力运动期间对 24 例 HFpEF 患者和 9 例无心力衰竭症状的患者进行 RV 和左心室压力-容积环的侵入性测量。使用短暂的前负荷降低来推断 RV 收缩末期弹性和舒张僵硬常数。HFpEF 患者和对照组的左心室和 RV 尺寸以及射血分数相似，但左心室充盈压升高。在 HFpEF 患者中，RV 收缩力（=0.04）和 RV 被动僵硬常数β（<0.01）等负荷独立 RV 收缩力和被动 RV 僵硬常数升高。尽管 RV 舒张和心输出量在基线时相似，但 HFpEF 患者在运动时心输出量的增加减弱（=0.01），与 RV 舒张延长（=0.01）、每搏量降低（<0.01）、RV 充盈压升高（<0.01）和舒张末期压力-容积关系明显增加（<0.01）相关。
在 HFpEF 综合征的代偿期，RV 收缩功能保持不变，但存在固有 RV 僵硬和 RV 舒张延长的舒张异常。舒张性 RV 储备功能受损导致在运动时心输出量增加减弱。由于舒张功能障碍似乎是一种双心室现象，因此在对 HFpEF 患者进行特征描述时，应进一步考虑 RV 舒张功能障碍。
