Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA; Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.
Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA; Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA.
J Card Fail. 2023 Nov;29(11):1477-1489. doi: 10.1016/j.cardfail.2023.04.008. Epub 2023 Apr 26.
Clinical and echocardiographic features may carry diverse information about the development of heart failure (HF). Therefore, we determined heterogeneity in clinical and echocardiographic phenotypes and its association with exercise capacity.
In 2036 community-dwelling individuals, we defined echocardiographic profiles of left and right heart remodeling and dysfunction. We subdivided the cohort based on presence (+) or absence (-) of HF risk factors (RFs) and echocardiographic abnormalities (RF-/Echo-, RF-/Echo+, RF+/Echo-, RF+/Echo+). Multivariable-adjusted associations between subgroups and physical performance metrics from 6-minute walk and treadmill exercise testing were assessed.
The prevalence was 35.3% for RF-/Echo-, 4.7% for RF-/Echo+, 39.3% for RF+/Echo-, and 20.6% for RF+/Echo+. We observed large diversity in echocardiographic profiles in the Echo+ group. Participants with RF-/Echo+ (18.6% of Echo+) had predominantly echocardiographic abnormalities other than left ventricular (LV) diastolic dysfunction, hypertrophy and reduced ejection fraction, whereas their physical performance was similar to RF-/Echo-. In contrast, participants with RF+/Echo+ presented primarily with LV hypertrophy or dysfunction, features that related to lower 6-minute walking distance and lower exercise capacity.
Subclinical echocardiographic abnormalities suggest HF pathogenesis, but the presence of HF risk factors and type of echo abnormality should be considered so as to distinguish adverse from benign adaptation and to stratify HF risk.
临床和超声心动图特征可能携带有关心力衰竭（HF）发展的不同信息。因此，我们确定了临床和超声心动图表型的异质性及其与运动能力的关系。
在 2036 名居住在社区的个体中，我们定义了左心和右心重构和功能障碍的超声心动图特征。我们根据是否存在 HF 危险因素（RFs）和超声心动图异常（RF-/Echo-、RF-/Echo+、RF+/Echo-、RF+/Echo+）对队列进行细分。使用多变量调整评估亚组与 6 分钟步行和跑步机运动测试的身体表现指标之间的关联。
RF-/Echo-的患病率为 35.3%，RF-/Echo+为 4.7%，RF+/Echo-为 39.3%，RF+/Echo+为 20.6%。我们观察到 Echo+组中的超声心动图特征存在很大的多样性。RF-/Echo+的参与者（Echo+的 18.6%）主要存在除左心室（LV）舒张功能障碍、肥大和射血分数降低以外的超声心动图异常，而他们的身体表现与 RF-/Echo-相似。相比之下，RF+/Echo+的参与者主要表现为 LV 肥大或功能障碍，这些特征与 6 分钟步行距离较短和运动能力较低有关。
亚临床超声心动图异常提示 HF 发病机制，但应考虑 HF 危险因素的存在和超声心动图异常的类型，以区分不利和良性适应，并分层 HF 风险。
