Oganesyan Research Institute of Cardiology, Yerevan; Mkhitar Heratsi Yerevan State Medical University, Yerevan.
Oganesyan Research Institute of Cardiology, Yerevan.
Kardiologiia. 2023 Aug 31;63(8):33-41. doi: 10.18087/cardio.2023.8.n1682.
Aim To study echocardiographic parameters of heart chamber strain in patients with left ventricular (LV) preclinical diastolic dysfunction (PDD) for determining predictors of the PDD transition to heart failure with preserved LV ejection fraction (HFpEF).Material and methods The study included 113 patients (including 69 women) with metabolic syndrome and LV PDD (mean age, 65±7 years). The control group consisted of 40 healthy individuals (mean age, 63.0±6.0 years, including 59% women). Metabolic syndrome was diagnosed in consistency with criteria of NCEP-ATP III 2001. PDD was diagnosed based on the absence of heart failure symptoms, normal level of brain natriuretic peptide, and the presence of at least three of the following echocardiographic criteria at rest or after diastolic stress-echocardiography (stress-echoCG): left atrial volume index (LAVI) >34 ml / m2; the ratio of peak early transmitral filling velocity (E) to average lateral and medial mitral annular velocity (e'), Е / е' >14, е' <8.5, and peak tricuspid regurgitation velocity >2.8 m /s. EchoCG that determined LV longitudinal strain (LS), right ventricular (RV) LS, right atrial (RA) LS, and left atrial (LA) LS was performed every year during the 3-year follow-up.Results During the follow-up period, 31 patients developed HFpEF. 19 of them reported symptoms while in the other 12 patients, HFpEF was detected by diastolic stress-echoCG. Patients with HFpEF had significantly lower absolute values of RV LS, LA LS, and RA LS (-27.8±2.9 in the PDD group vs. -23.8±3.2 in the HFpEF group; р<0.03; 38.2±9.1 vs. 28.6±10.2; р<0.03; and 46.2±10.4 vs. 31.6±8.3; р<0.03, respectively). RV LS and RA LS were the strongest independent predictors for PDD transformation into HFpEF (odds ratio, OR, 2.7; 95 % confidence interval, CI, 1.48-2.91; р<0.001 and OR 2.6; 95 % CI: 1.40-2.75; р<0.001, respectively).Conclusion PDD is not a separate clinical nosology but rather an initial stage in the pathogenesis of HFpEF. Approximately ⅓ of PDD patients develop HFpEF. RV LS and RA LS are considered predictors of HFpEF. The duration of PDD is apparently an important factor that provides the development of HFpEF.
目的 研究左心室（LV）亚临床舒张功能障碍（PDD）患者的心脏腔室应变超声心动图参数，以确定 PDD 向射血分数保留心力衰竭（HFpEF）转变的预测因子。
材料和方法 本研究纳入了 113 例（包括 69 名女性）代谢综合征合并 LV PDD 患者（平均年龄 65±7 岁）。对照组由 40 名健康个体组成（平均年龄 63.0±6.0 岁，包括 59%的女性）。代谢综合征的诊断符合 NCEP-ATP III 2001 年的标准。PDD 的诊断基于无心力衰竭症状、脑利钠肽水平正常以及静息或舒张后负荷超声心动图（负荷超声心动图）至少存在以下三个超声心动图标准：左心房容积指数（LAVI）>34ml/m2；E 峰与平均外侧和内侧二尖瓣环速度（e'）的比值（E/e'）>14，e'<8.5，三尖瓣反流速度峰值>2.8m/s。在 3 年的随访期间，每年进行一次超声心动图检查，以确定左室纵向应变（LS）、右室（RV）LS、右心房（RA）LS 和左心房（LA）LS。
结果 在随访期间，31 例患者发展为 HFpEF。其中 19 例有症状，而在另外 12 例患者中，HFpEF 通过舒张负荷超声心动图检测到。HFpEF 患者的 RV LS、LA LS 和 RA LS 的绝对值明显较低（PDD 组为-27.8±2.9，HFpEF 组为-23.8±3.2；p<0.03；38.2±9.1，28.6±10.2；p<0.03；和 46.2±10.4，31.6±8.3；p<0.03）。RV LS 和 RA LS 是 PDD 向 HFpEF 转化的最强独立预测因子（优势比，OR，2.7；95%置信区间，CI，1.48-2.91；p<0.001 和 OR 2.6；95%CI：1.40-2.75；p<0.001）。
结论 PDD 不是一个独立的临床分类，而是 HFpEF 发病机制的初始阶段。大约三分之一的 PDD 患者发展为 HFpEF。RV LS 和 RA LS 被认为是 HFpEF 的预测因子。PDD 的持续时间显然是提供 HFpEF 发展的一个重要因素。
