Department of Internal Medicine/Cardiology, Heart Center Leipzig, University Hospital, Struempellstrasse 39, 04289, Leipzig, Germany.
Institute for Diagnostic and Interventional Radiology, Georg-August University, Göttingen, Germany.
Clin Res Cardiol. 2020 Jan;109(1):54-66. doi: 10.1007/s00392-019-01484-0. Epub 2019 May 3.
Right ventricular (RV) function is prognostically relevant in heart failure with preserved ejection fraction (HFpEF) but data on profound assessment of RV and right atrial (RA) interaction in HFpEF are lacking. The current study characterizes RV and RA interaction using invasive pressure-volume-loop analysis and cardiac magnetic resonance imaging (CMR) data.
We performed CMR and myocardial feature-tracking in 24 HFpEF patients and 12 patients without HFpEF. Invasive pressure-volume-loops were obtained to evaluate systolic and diastolic RV properties. RV early filling was determined from CMR RV volume-time curves. RV systolic function was slightly increased in HFpEF (RV EF 68 ± 8 vs. 60 ± 9%, p = 0.01), while no differences in RV stroke volume were found (45 ± 7 vs 42 ± 9 ml/m, p = 0.32). RV early filling was decreased in HFpEF (21 ± 11 vs. 40 ± 11% of RV filling volume, p < 0.01) and RV early filling was the strongest predictor for VO even after inclusion of invasively derived RV stiffness and relaxation constant (Beta 0.63, p < 0.01). RA conduit-function was lower in HFpEF (RA conduit-strain - 11 ± 5 vs. - 16 ± 4%, p < 0.01) while RA booster-pump-function was increased (RA active-strain - 18 ± 6 vs. - 12 ± 6%, p = 0.01) as a compensation. RV filling was associated with RA conduit-function (r = - 0.55, p < 0.01) but not with invasively derived RV relaxation constant.
In compensated HFpEF patients RV early filling was impaired and compensated by increased RA booster pump function, while RV systolic function was preserved. Impaired RV diastology and RA-RV interaction were linked to impaired exercise tolerance and RA-RV-coupling seems to be independent of RV relaxation, suggestive of an independent pathophysiological contribution of RA dysfunction in HFpEF.
CLINICAL-TRIAL-REGISTRATION: NCT02459626 (www.clinicaltrials.gov).
右心室（RV）功能在心衰伴射血分数保留（HFpEF）中具有预后相关性，但缺乏对 HFpEF 中 RV 和右心房（RA）相互作用的深入评估数据。本研究采用有创压力-容积环分析和心脏磁共振成像（CMR）数据来描述 RV 和 RA 的相互作用。
我们对 24 例 HFpEF 患者和 12 例非 HFpEF 患者进行了 CMR 和心肌特征追踪。获得有创压力-容积环以评估 RV 的收缩和舒张功能。从 CMR RV 容积-时间曲线确定 RV 早期充盈。HFpEF 患者的 RV 早期充盈减少（21±11%与 40±11%的 RV 充盈容积，p<0.01），而 RV 射血分数（RV EF 68±8%与 60±9%，p=0.01）仅略有增加。RV 早期充盈是 VO 的最强预测因素，即使包括有创性 RV 僵硬度和松弛常数（Beta 0.63，p<0.01）。HFpEF 患者的 RA 腔静脉功能降低（RA 腔静脉应变 -11±5%与 -16±4%，p<0.01），而 RA 助力泵功能增加（RA 主动应变 -18±6%与 -12±6%，p=0.01）以代偿。RV 充盈与 RA 腔静脉功能相关（r=-0.55，p<0.01），但与有创性 RV 松弛常数无关。
在代偿性 HFpEF 患者中，RV 早期充盈受损，由 RA 助力泵功能增加代偿，而 RV 收缩功能保持不变。RV 舒张功能障碍和 RA-RV 相互作用与运动耐量受损相关，RA-RV 耦合似乎独立于 RV 松弛，提示 RA 功能障碍在心衰伴射血分数保留中具有独立的病理生理学贡献。
NCT02459626（www.clinicaltrials.gov）。
