Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark.
Eur Heart J Cardiovasc Imaging. 2023 Jul 24;24(8):1110-1119. doi: 10.1093/ehjci/jead062.
Hypertensive heart disease (HHD) is recognized as a key clinical precursor to heart failure with preserved ejection fraction (HFPEF). However, pathophysiological transition from HHD to HFPEF is not well understood. We sought determine whether regional differences in impaired myocardial function may underlie the greater mechanical dysfunction seen in HFPEF compared to HHD.
We used standardized echocardiography to assess regional myocardial deformation in a cohort of n = 327 adults with preserved left ventricular (LV) ejection fraction (≥45%), including: n = 129 with HFPEF, n = 158 with HHD and no heart failure, and n = 40 normotensive controls. From detailed measurements of LV systolic strain performed in multiple views, we derived and then compared regional measures of basal, mid-ventricular, and apical longitudinal strains. In models adjusting for clinical covariates, basal and mid-ventricular LV myocardial deformation was more impaired in HHD than in controls (P ≤ 0.003), whereas apical deformation was more impaired in HFPEF than in HHD (P = 0.005). In multivariable-adjusted analyses, only apical strain remained independently associated with HFPEF vs. HHD status [odds ratio 1.18 (1.02-1.37), P = 0.030 per 1% decrease in apical strain]. Compared to other regional strains, apical longitudinal strain optimally differentiated HFPEF from HHD (area under the receiver operating curve: apical longitudinal strain = 0.67; mid-ventricular longitudinal strain = 0.59; basal longitudinal strain = 0.60).
We found that while apical mechanical function is preserved in HHD, it was impaired in HFPEF and may contribute to the transition from an asymptomatic heart disease to a symptomatic heart disease.
高血压性心脏病（HHD）被认为是射血分数保留型心力衰竭（HFPEF）的重要临床前期。然而，从 HHD 到 HFPEF 的病理生理转变尚不清楚。我们试图确定心肌功能受损的区域性差异是否是 HFPEF 比 HHD 出现更大机械功能障碍的基础。
我们使用标准化超声心动图评估了 n = 327 名射血分数保留（≥45%）的成年人的区域性心肌变形，包括：n = 129 名 HFPEF 患者，n = 158 名 HHD 且无心力衰竭患者，和 n = 40 名血压正常的对照者。从多个视图中进行的 LV 收缩应变的详细测量中，我们推导出并比较了基础、中心室和心尖长轴应变的区域性测量值。在调整临床协变量的模型中，HHD 的 LV 心肌基础和中心室变形比对照组更受损（P ≤ 0.003），而 HFPEF 的心尖变形比 HHD 更受损（P = 0.005）。在多变量调整分析中，仅心尖应变与 HFPEF 与 HHD 状态独立相关[比值比 1.18（1.02-1.37），每降低 1%心尖应变 P = 0.030]。与其他区域性应变相比，心尖纵向应变可最佳地区分 HFPEF 与 HHD（接受者操作特征曲线下面积：心尖纵向应变= 0.67；中心室纵向应变= 0.59；基底纵向应变= 0.60）。
我们发现，虽然 HHD 中心尖机械功能正常，但在 HFPEF 中受损，这可能导致从无症状性心脏病向有症状性心脏病的转变。
