Department of Cardiovascular Ultrasound, First Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China.
Department of Cardiology, First Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China.
Int J Cardiol. 2018 Apr 15;257:177-181. doi: 10.1016/j.ijcard.2017.12.042.
To assess LA diastolic and systolic function and atrial dyssynchrony in patients with heart failure with preserved ejection fraction (HFpEF) and to examine whether LA dysfunction and dyssynchrony account for the patients' symptoms of HFpEF.
Fifty-five patients with HFpEF, 31 asymptomatic patients with left ventricular diastolic dysfunction (LVDD) and 33 healthy individuals were enrolled in the study. The LA active ejection fraction (LAAEF) was calculated. The peak atrial longitudinal systolic strain (PALS) and peak atrial contraction strain (PACS) were measured using speckle tracking echocardiography (STE). Atrial dyssynchrony including inter-atrial dyssynchrony, LA dyssynchrony and right atrial dyssynchrony were calculated by tissue Doppler imaging (TDI).
The PALS and PACS were deteriorated, whereas inter-atrial dyssynchrony was prolonged in patients with HFpEF (20.41±7.41%, 10.83±4.19%, 31±15ms, respectively) compared with the values obtained in asymptomatic LVDD patients (26.61±6.30%, 13.23±4.52%, 19±12ms, respectively) and those found in normal individuals (33.51±6.74%, 14.17±2.88%, 17±12ms, respectively) (P<0.05). However, PACS and inter-atrial dyssynchrony did not reach statistical significance between asymptomatic LVDD and normal individuals (P>0.05). Moreover, patients with deteriorated clinical symptoms (NYHA>II) presented worse LA systolic function and prolonged dyssynchrony compared with those with NYHA=II. Inter-atrial dyssynchrony and LAAEF are independently associated with worse NYHA functional classes in patients with HFpEF.
LA diastolic and systolic function were significantly impaired, and inter-atrial dyssynchrony was prolonged in patients with HFpEF. Decreased LA systolic function and prolonged inter-atrial dyssynchrony were possibly associated with deteriorated clinical symptoms.
评估射血分数保留的心力衰竭（HFpEF）患者的左心房（LA）舒张和收缩功能以及房性不同步，并探讨 LA 功能障碍和不同步是否与 HFpEF 患者的 HFpEF 症状有关。
本研究纳入了 55 例 HFpEF 患者、31 例无症状左心室舒张功能障碍（LVDD）患者和 33 名健康个体。计算左房主动射血分数（LAAEF）。应用斑点追踪超声心动图（STE）测量峰值心房纵向收缩应变（PALS）和峰值心房收缩应变（PACS）。组织多普勒成像（TDI）计算房性不同步，包括房间隔不同步、LA 不同步和右心房不同步。
与无症状 LVDD 患者（分别为 26.61±6.30%、13.23±4.52%、19±12ms）和正常个体（分别为 33.51±6.74%、14.17±2.88%、17±12ms）相比，HFpEF 患者的 PALS 和 PACS 降低，而房间隔不同步延长（分别为 20.41±7.41%、10.83±4.19%、31±15ms，P<0.05）。然而，无症状 LVDD 与正常个体之间的 PACS 和房间隔不同步无统计学差异（P>0.05）。此外，与 NYHA=II 级患者相比，临床症状恶化（NYHA>II 级）的患者 LA 收缩功能更差，不同步时间更长。HFpEF 患者中，房间隔不同步和 LAAEF 与较差的 NYHA 心功能分级独立相关。
HFpEF 患者的 LA 舒张和收缩功能明显受损，房间隔不同步延长。LA 收缩功能降低和房间隔不同步延长可能与临床症状恶化有关。
