Kerstens Thijs P, Weerts Jerremy, van Dijk Arie P J, Weijers Gert, Knackstedt C, Eijsvogels Thijs M H, Oxborough David, van Empel Vanessa P M, Thijssen Dick H J
Department of Medical BioSciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands; Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands.
Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+), P. Debyeplein 25, 6200 MD Maastricht, the Netherlands.
Int J Cardiol. 2023 May 1;378:144-150. doi: 10.1016/j.ijcard.2023.01.084. Epub 2023 Feb 14.
Presence of left ventricular diastolic dysfunction (DD) is key in the pathogenesis of heart failure with preserved ejection fraction (HFpEF). However, non-invasive assessment of diastolic function is complex, cumbersome, and largely based on consensus recommendations. Novel imaging techniques may help detecting DD. Therefore, we compared left ventricular strain-volume loop (SVL) characteristics and diastolic (dys-)function in suspected HFpEF patients.
257 suspected HFpEF patients with sinus rhythm during echocardiography were prospectively included. 211 patients with quality-controlled images and strain and volume analysis were classified according to the 2016 ASE/EACVI recommendations. Patients with indeterminate diastolic function were excluded, resulting in two groups: normal diastolic function (control; n = 65) and DD (n = 91). Patients with DD were older (74.8 ± 6.9 vs. 68.5 ± 9.4 years, p < 0.001), more often female (88% vs 72%, p = 0.021), and more often had a history of atrial fibrillation (42% vs. 23%, p = 0.024) and hypertension (91% vs. 71%, p = 0.001) compared to normal diastolic function. SVL analysis showed a larger uncoupling i.e., a different longitudinal strain contribution to volume change, in DD compared to controls (0.556 ± 1.10% vs. -0.051 ± 1.14%, respectively, P < 0.001). This observation suggests different deformational properties during the cardiac cycle. After adjustment for age, sex, history of atrial fibrillation and hypertension, we found an adjusted odds ratio of 1.68 (95% confidence interval 1.19-2.47) for DD per unit increase in uncoupling (range: -2.95-3.20).
Uncoupling of the SVL is independently associated with DD. This might provide novel insights in cardiac mechanics and new opportunities to assess diastolic function non-invasively.
左心室舒张功能障碍（DD）的存在是射血分数保留的心力衰竭（HFpEF）发病机制的关键。然而，舒张功能的非侵入性评估复杂、繁琐，且很大程度上基于共识推荐。新型成像技术可能有助于检测DD。因此，我们比较了疑似HFpEF患者的左心室应变-容积环（SVL）特征和舒张（功能障碍）功能。
前瞻性纳入257例在超声心动图检查时有窦性心律的疑似HFpEF患者。对211例图像质量控制良好且进行了应变和容积分析的患者，根据2016年美国超声心动图学会/欧洲心血管影像学会（ASE/EACVI）的推荐进行分类。舒张功能不确定的患者被排除，最终分为两组：舒张功能正常（对照组；n = 65）和舒张功能障碍（n = 91）。与舒张功能正常的患者相比，舒张功能障碍患者年龄更大（74.8±6.9岁 vs. 68.5±9.4岁，p < 0.001），女性比例更高（88% vs 72%，p = 0.0
