Gotsman Israel, Leibowitz David, Keren Andre, Amir Offer, Zwas Donna R
Heart Institute, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
Heart Institute, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
Am J Cardiol. 2023 Jan 15;187:119-126. doi: 10.1016/j.amjcard.2022.10.029. Epub 2022 Nov 29.
A hyperdynamic heart is defined as a left ventricular (LV) with an ejection fraction (EF) above the normal range. Is this favorable? We looked at the diastolic properties of subjects with a hyperdynamic heart and its impact on outcome. Consecutive echocardiography examinations during 5 years were evaluated by EF subgroups, including a hyperdynamic heart (EF >70%). All examinations with significant LV hypertrophy or valve disease were excluded. The study included 16,994 subjects. A total of 720 subjects (4.2%) had a hyperdynamic heart. Subjects with a hyperdynamic heart were older, more likely to be women, and more likely to have hypertension, diabetes, and obesity. A total of 20% of patients had a diagnosis of heart failure. This group had a higher heart rate, smaller ventricular size, and the highest relative wall thickness. All indexes of diastolic dysfunction were significantly more prevalent in the hyperdynamic group. This included a higher LV mass, larger left atrial volume, reduced relaxation (smaller mitral e'), longer deceleration time, and higher LV end-diastolic pressures (high mitral E/e' ratio) and peak tricuspid regurgitation gradient. Diastolic dysfunction, defined by an abnormal functional or structural parameter, was present in 78% of the subjects. Survival was significantly lower in the group with a hyperdynamic heart. The Cox regression analysis after adjustment demonstrated reduced survival during a median 9-year follow-up in the hyperdynamic group compared with those with a normal EF (hazard ratio 1.56, 95% confidence interval 1.38 to 1.76, p <0.001). In conclusion, subjects with a hyperdynamic systolic function have increased prevalence of diastolic dysfunction and reduced survival. A hyperdynamic heart is not a normally functioning heart.
高动力心脏被定义为左心室射血分数（EF）高于正常范围。这是有利的吗？我们研究了高动力心脏患者的舒张功能及其对预后的影响。通过EF亚组对5年内连续的超声心动图检查进行评估，包括高动力心脏（EF>70%）。排除所有有显著左心室肥厚或瓣膜疾病的检查。该研究纳入了16994名受试者。共有720名受试者（4.2%）患有高动力心脏。高动力心脏的受试者年龄更大，更可能为女性，更可能患有高血压、糖尿病和肥胖。共有20%的患者被诊断为心力衰竭。该组心率更高，心室尺寸更小，相对壁厚度最高。舒张功能障碍的所有指标在高动力组中明显更为普遍。这包括更高的左心室质量、更大的左心房容积、舒张功能降低（二尖瓣E峰减小）、减速时间延长、更高的左心室舒张末压（二尖瓣E/A比值高）和三尖瓣反流峰值梯度。由异常功能或结构参数定义的舒张功能障碍存在于78%的受试者中。高动力心脏组的生存率显著较低。调整后的Cox回归分析表明，与EF正常的受试者相比，高动力组在中位9年随访期间生存率降低（风险比1.56，95%置信区间1.38至1.76，p<0.001）。总之，收缩功能高动力的受试者舒张功能障碍患病率增加，生存率降低。高动力心脏并非功能正常的心脏。
