Wang Yi, Ciampi Quirino, Cortigiani Lauro, Zagatina Angela, Kasprzak Jaroslaw D, Wierzbowska-Drabik Karina, Haberka Maciej, Lowenstein Jorge, Arbucci Rosina, Haber Diego M Lowenstein, Marconi Sofia, Merlo Pablo M, Barral Patricia, Souto Germán, Djordjevic-Dikic Ana, Reisenhofer Barbara, Boshchenko Alla, Ryabova Tamara, Rodriguez-Zanella Hugo, Rigo Fausto, D'Andrea Antonello, Gaibazzi Nicola, Merli Elisa, Lisi Matteo, Simova Iana, Barbieri Andrea, Morrone Doralisa, Pitino Annalisa, De Nes Michele, Tripepi Giovanni L, Yin Lixue, Citro Rodolfo, Carerj Scipione, Pepi Mauro, Pellikka Patricia A, Picano Eugenio
Department of Cardiovascular Ultrasound and Non-Invasive Cardiology, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Chengdu, China.
Cardiology Division Fatebenefratelli Hospital of Benevento, Benevento, Italy.
Int J Cardiovasc Imaging. 2024 Oct 10. doi: 10.1007/s10554-024-03240-6.
Hypercontractile phenotype (HP) of the left ventricle (LV) is an actionable therapeutic target in patients with chronic coronary syndromes (CCS) or heart failure (HF), but its clinical recognition remains difficult. To assess the clinical variables associated with the HP. In a prospective, observational, multicenter study, we recruited 5122 patients (age 65 ± 11 years, 2974 males, 58%) with CCS and/or HF with preserved ejection fraction (EF). Systolic blood pressure (SBP) was measured. We assessed wall motion score index (WMSI), LV end-diastolic volume (EDV), end-systolic volume (ESV), EF, force (SBP/ESV), stroke volume (SV), arterial elastance (SBP/SV), and ventricular-arterial coupling (VAC, as SV/ESV). Univariable and multivariable logistic regression analysis assessed independent factors associated with the highest force sextile. For all the studied patients, force was 4.51 ± 2.11 mmHg/ml, with the highest sextile (Group 6) > 6.36 mmHg/ml. By multivariable logistic regression model, the highest sextile of force was associated with age > 65 years (OR 1.62, 95% CI 1.36-1.93, p < 0.001), hypertension (OR 1.76, 95% CI 1.40-2.21, p < 0.001), female sex (OR 4.52, 95% CI 3.77-5.42, p < 0.001), absence of beta-blocker therapy (OR 1.41, 95% CI 1.16-1.68), rest SBP ≥ 160 mmHg (OR 2.81, 95% CI 2.21-3.56, p < 0.001), high heart rate (OR 2.08, 95% CI 1.61-2.67, p < 0.001), and absence of prior myocardial infarction (OR 1.34, 95% CI 1.07-1.68, p = 0.012). Patients in the highest sextile of force showed lower values of WMSI, SV, EDV, and ESV, and higher values of arterial elastance and VAC. HP of the LV with high force was clinically associated with advanced age, female sex, high resting SBP, and the absence of β-blocker therapy. By transthoracic echocardiography, HP was associated with a small heart with reduced EDV, reduced SV despite high EF, and higher arterial elastance.
左心室（LV）的高收缩表型（HP）是慢性冠状动脉综合征（CCS）或心力衰竭（HF）患者可采取治疗措施的治疗靶点，但其临床识别仍然困难。为了评估与HP相关的临床变量。在一项前瞻性、观察性、多中心研究中，我们招募了5122例CCS和/或射血分数（EF）保留的HF患者（年龄65±11岁，男性2974例，占58%）。测量收缩压（SBP）。我们评估了壁运动评分指数（WMSI）、左心室舒张末期容积（EDV）、收缩末期容积（ESV）、EF、力（SBP/ESV）、每搏输出量（SV）、动脉弹性（SBP/SV）和心室-动脉耦合（VAC，即SV/ESV）。单变量和多变量逻辑回归分析评估了与最高力六分位数相关的独立因素。对于所有研究患者，力为4.51±2.11mmHg/ml，最高六分位数（第6组）>6.36mmHg/ml。通过多变量逻辑回归模型，最高力六分位数与年龄>65岁（OR 1.62，95%CI 1.36-1.93，p<0.001）、高血压（OR 1.76，95%CI 1.40-2.21，p<0.001）、女性（OR 4.52，95%CI 3.77-5.42，p<0.001）、未接受β受体阻滞剂治疗（OR 1.41，95%CI 1.16-1.68）、静息SBP≥160mmHg（OR 2.81，95%CI 2.21-3.56，p<0.001）、高心率（OR 2.08，95%CI 1.61-2.67，p<0.001）以及无既往心肌梗死（OR 1.34，95%CI 1.07-1.68，p=0.012）相关。力最高六分位数的患者WMSI、SV、EDV和ESV值较低，而动脉弹性和VAC值较高。左心室高收缩力的HP在临床上与高龄、女性、高静息SBP以及未接受β受体阻滞剂治疗相关。通过经胸超声心动图检查，HP与心脏较小、EDV减少、尽管EF高但SV减少以及动脉弹性较高有关。
