Oki Takashi, Miyoshi Hirokazu, Oishi Yoshifumi, Iuchi Arata, Kusunose Kenya, Yamada Hirotsugu, Klein Allan L
Cardiovascular Section, Higashi Tokushima Medical Center, National Hospital Organization Tokushima Japan.
Department of Cardiovascular Medicine, Tokushima University Hospital Tokushima Japan.
Circ Rep. 2018 Dec 14;1(1):8-16. doi: 10.1253/circrep.CR-18-0017.
At present, heart failure with preserved ejection fraction (HFpEF) is a commonly accepted condition in HF patients. In contrast to HF with reduced EF (HFrEF), HFpEF is strongly associated with aging, and vascular, metabolic, neurohormonal, and systemic inflammatory comorbidities. Two major hypotheses explain the pathophysiology of HFpEF (stages C,D in the American College of Cardiology Foundation/American Heart Association HF staging system): (1) impaired active relaxation and increased passive stiffness of the left ventricular (LV) myocardium during diastole (left atrial [LA]-LV coupling); and (2) LV and arterial stiffening during systole (LV-arterial coupling). Cardiac structural and functional abnormalities can be evaluated using non-invasive measures, such as 2-D, flow velocity Doppler, and tissue Doppler echocardiography, to estimate LV filling pressure and afterload mismatch. The clinical application of 2-D speckle-tracking echocardiography (2D-STE) is feasible for earlier diagnosis of functional abnormalities of the LA, LV, and elastic arteries in asymptomatic patients with cardiovascular risk factors (stages A,B). The goal of this review is to highlight the role of 2D-STE to detect impairment of LA-LV-arterial coupling beyond diastolic function earlier, because it may provide important information on the pathophysiology and prevention of HFpEF.
目前，射血分数保留的心力衰竭（HFpEF）是心力衰竭患者中一种公认的病症。与射血分数降低的心力衰竭（HFrEF）不同，HFpEF与衰老以及血管、代谢、神经激素和全身炎症合并症密切相关。有两种主要假说来解释HFpEF的病理生理学（美国心脏病学会基金会/美国心脏协会心力衰竭分期系统中的C、D期）：（1）舒张期左心室（LV）心肌主动舒张受损和被动僵硬度增加（左心房[LA]-LV耦联）；（2）收缩期LV和动脉僵硬度增加（LV-动脉耦联）。心脏结构和功能异常可通过二维、流速多普勒和组织多普勒超声心动图等非侵入性测量方法进行评估，以估计LV充盈压和后负荷不匹配情况。二维斑点追踪超声心动图（2D-STE）在有心血管危险因素的无症状患者（A、B期）中，对于早期诊断LA、LV和弹性动脉的功能异常是可行的。本综述的目的是强调2D-STE在更早检测出超出舒张功能的LA-LV-动脉耦联受损方面的作用，因为它可能为HFpEF的病理生理学和预防提供重要信息。
