Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, and Department of Cardiology, Södersjukhuset, SE-118 83, Stockholm, Sweden.
National Heart Centre, Singapore, 5 Hospital Drive, Singapore, 169609, Singapore.
Cardiovasc Ultrasound. 2020 Nov 20;18(1):46. doi: 10.1186/s12947-020-00228-9.
Diastolic dysfunction can be caused by hypertension or diabetes mellitus, and it is also often found with increasing age. In a given patient, the cause of diastolic dysfunction is therefore not always obvious. We sought to study the interplay of these risk factors for diastolic dysfunction in an outpatient population with a low likelihood of ischemic heart disease.
Consecutive patients referred for stress echocardiography were included retrospectively. Exclusion criteria included pathological stress response, atrial arrhythmia, left ventricular ejection fraction < 55%, and more than mild valvular disease. Standard diastolic parameters were recorded in all patients. In a subset of patients, mechanistic analysis of early filling was performed using the parameterized diastolic filling (PDF) method.
We included 726 patients (median [interquartile range] age 56 (44-65) years, 57% male). The prevalence of diabetes and hypertension was 43 and 49%, respectively. In multiple linear regression modeling, the presence of diabetes, hypertension, sex and increasing age explained a moderate amount of the variance in e' velocities, E/A ratio and E/e' (R = 0.31-0.48, p < 0.001), and a low amount of the variance in left atrial volume index (LAVI) and the PDF parameters (n = 446, R = 0.05-0.17, p < 0.001). Sex was only related to LAVI and E/e' for the conventional parameters (beta - 0.94, p = 0.04, and beta - 0.91, p < 0.001, respectively).
Diabetes, hypertension, increasing age, and to a lesser extent sex, explain a moderate amount of the variance in conventional diastolic parameters related to myocardial tissue velocities and E/A ratio in a healthy outpatient population. The effect of these risk factors was substantially less pronounced on left atrial volume index and the PDF parameters.
舒张功能障碍可由高血压或糖尿病引起，也常随年龄增长而出现。因此，在特定患者中，舒张功能障碍的病因并非总是显而易见的。我们试图研究这些危险因素在患有低缺血性心脏病风险的门诊人群中的相互作用。
回顾性纳入连续因应激超声心动图而就诊的患者。排除标准包括病理性应激反应、房性心律失常、左心室射血分数<55%以及更严重的瓣膜疾病。所有患者均记录标准舒张参数。在部分患者中，采用参数化舒张充盈（PDF）法进行早期充盈的机制分析。
共纳入 726 例患者（中位数[四分位间距]年龄为 56（44-65）岁，57%为男性）。糖尿病和高血压的患病率分别为 43%和 49%。多元线性回归模型显示，糖尿病、高血压、性别和年龄增加可解释 e'速度、E/A 比值和 E/e'的中等程度变异（R=0.31-0.48，p<0.001），以及左心房容积指数（LAVI）和 PDF 参数的低程度变异（n=446，R=0.05-0.17，p<0.001）。性别仅与传统参数的 LAVI 和 E/e'相关（beta -0.94，p=0.04，和 beta -0.91，p<0.001）。
在健康的门诊人群中，糖尿病、高血压、年龄增长以及在一定程度上的性别，可解释与心肌组织速度和 E/A 比值相关的传统舒张参数的中等程度变异。这些危险因素对左心房容积指数和 PDF 参数的影响要小得多。
