Hoshida Shiro, Watanabe Tetsuya, Masunaga Nobutaka, Shinoda Yukinori, Seo Masahiro, Hayashi Takaharu, Yano Masamichi, Yamada Takahisa, Yasumura Yoshio, Hikoso Shungo, Okada Katsuki, Nakatani Daisaku, Sotomi Yohei, Sakata Yasushi
Department of Cardiovascular Medicine, Yao Municipal Hospital, 1-3-1 Ryuge-cho, Yao 581-0069, Japan.
Division of Cardiology, Osaka General Medical Center, Osaka 558-8558, Japan.
J Clin Med. 2024 Oct 3;13(19):5911. doi: 10.3390/jcm13195911.
: Coronary microvascular dysfunction (CMD) is associated with many heart diseases, including heart failure (HF) with preserved ejection fraction (HFpEF). Invasive examinations for CMD detection are difficult in older patients with HFpEF, and the decision criteria for noninvasive CMD measurements are unclear. We aimed to identify alternative factors in the possible involvement of CMD in the progression and prognosis of HFpEF. : We analyzed 607 patients with HFpEF who were hospitalized for acute decompensated HF without a history of coronary artery disease (CAD). Blood tests and transthoracic echocardiography were performed. We focused on left ventricular hypertrophy (LVH) and coronary perfusion pressure (diastolic blood pressure, dBP). : The patients with LVH showed reduced diastolic function (E/e') and a lower incidence of atrial fibrillation (AF) compared with those without LVH, with no differences in age or dBP. No differences were observed in all-cause mortality between patients with low and high dBP without LVH. In the patients with LVH, the incidence of all-cause mortality was significantly higher, with a lower incidence of AF, reduced renal function, and higher C-reactive protein levels in those with low dBP than in those with high dBP. The comprehensive diastolic functional index, diastolic elastance/arterial elastance, was markedly higher in the patients with LVH, especially in those with all-cause mortality. This index, but not E/e', was a significant prognostic index in the multivariate Cox hazard analysis when adjusting for age, sex and N-terminal pro-brain natriuretic peptide levels. : LVH and dBP were clinically important factors in elderly HFpEF patients without a history of CAD.
冠状动脉微血管功能障碍（CMD）与多种心脏病相关，包括射血分数保留的心力衰竭（HFpEF）。对于老年HFpEF患者，检测CMD的侵入性检查存在困难，且非侵入性CMD测量的判定标准尚不清楚。我们旨在确定可能参与HFpEF进展和预后的CMD的替代因素。
我们分析了607例因急性失代偿性HF住院且无冠状动脉疾病（CAD）病史的HFpEF患者。进行了血液检查和经胸超声心动图检查。我们重点关注左心室肥厚（LVH）和冠状动脉灌注压（舒张压，dBP）。
与无LVH的患者相比，LVH患者的舒张功能（E/e'）降低，房颤（AF）发生率较低，年龄和dBP无差异。无LVH的低dBP和高dBP患者的全因死亡率无差异。在LVH患者中，低dBP患者的全因死亡率显著更高，AF发生率更低，肾功能降低，C反应蛋白水平更高。综合舒张功能指数，即舒张弹性/动脉弹性，在LVH患者中明显更高，尤其是在全因死亡患者中。在调整年龄、性别和N末端脑钠肽前体水平后，该指数而非E/e'在多变量Cox风险分析中是一个显著的预后指标。
LVH和dBP是无CAD病史的老年HFpEF患者的重要临床因素。
