Shirokov N E, Enina T N, Zueva E V, Yaroslavskaya E I, Krinochkin D V, Musikhina N A, Petelina T I, Gapon L I
Tyumen Cardiological Research Center, Tomsk National Research Medical Center of the Russian Academy of Sciences, Tomsk.
Kardiologiia. 2024 Dec 24;64(12):51-58. doi: 10.18087/cardio.2024.12.n2706.
To study the relationship between laboratory markers and echocardiography (EchoCG) parameters in heart failure with preserved ejection fraction (HFpEF) depending on the results of the diastolic stress test (DST).
The diagnostic algorithm provided by the current guidelines for the assessment of left ventricular (LV) diastolic function was used to select patients. If there were not enough criteria to make a conclusion about increased LV filling pressure (FP) based on standard resting echocardiography data in patients with arterial hypertension and ischemic heart disease, DST was performed to detect HFpEF. 80 patients (50.0% men, mean age 66.3±5.4 years) were included. Group 1 consisted of 41 patients with a positive DST, and group 2 included 39 patients with a negative DST. Concentrations of the markers of immune inflammation, endothelial dysfunction, collagen homeostasis, and myocardial stress were measured.
The DST showed significant differences in the E/e' ratio (15.1 [13.4; 15.9] in group 1 and 9.5 [7.9; 10.3] in group 2, respectively, p<0.001) and the diastolic functional reserve index (DFRI) (9.8 [6.8; 14.0] and 21.0 [13.0; 29.0], p < 0.001). Resting EchoCG revealed significant differences in the left atrial reservoir strain (LASr) (22.8 [19.6; 25.6]% and 28.0 [24.8; 30.2]%, p<0.001) and the left atrial stiffness index (LASI) (0.50 [0.40; 0.57] and 0.34 [0.27; 0.41], p<0.001). In patients with HFpEF, the laboratory parameters of collagen regulation had the greatest number of relationships. Correlations were found between the concentrations of matrix metalloproteinase-9 and other biomarkers, including interleukin-10 (IL-10) (r=0.311; p=0.048), myeloperoxidase (r=0.382; p=0.014), N-terminal propeptide of procollagen type I (procollagen I N-terminal propeptide, PINP) (r=0.722; p<0.001) and type III (r=0.591; p<0.001), C-terminal propeptide of procollagen type I (r=0.330; p=0.035), tissue inhibitor of metalloproteinases type 1 (r=0.410; p=0.008), EchoCG parameters, including left atrial volume index (LAVI) (r=0.414; p=0.007) and DFRI (r=0.354; p=0.025). In addition, correlations were found for the concentrations of PINP with IL-10 (r=0.401; p=0.009) and endothelin-1 (r= -0.337; p=0.031); PINP with LAVI (r=0.498; p=0.001) and DFRI (r=0.420; p=0.007).
Patients with HFpEF have a greater number of relationships between markers of collagen homeostasis disorders and EchoCG parameters characterizing an increase in LV FP.
根据舒张期负荷试验（DST）结果，研究射血分数保留的心力衰竭（HFpEF）患者的实验室指标与超声心动图（EchoCG）参数之间的关系。
采用当前指南中评估左心室（LV）舒张功能的诊断算法来选择患者。对于患有动脉高血压和缺血性心脏病的患者，如果根据标准静息超声心动图数据不足以得出LV充盈压（FP）升高的结论，则进行DST以检测HFpEF。共纳入80例患者（男性占50.0%，平均年龄66.3±5.4岁）。第1组由41例DST阳性患者组成，第2组包括39例DST阴性患者。测量了免疫炎症、内皮功能障碍、胶原稳态和心肌应激标志物的浓度。
DST显示E/e'比值（第1组为15.1[13.4；15.9]，第2组为9.5[7.9；10.3]，p<0.001）和舒张功能储备指数（DFRI）（9.8[6.8；14.0]和21.0[13.0；29.0]，p<0.001）存在显著差异。静息EchoCG显示左心房储备应变（LASr）（22.8[19.6；25.6]%和28.0[24.8；30.2]%，p<0.001）和左心房僵硬度指数（LASI）（0.50[0.40；0.57]和0.34[0.27；0.41]，p<0.001）存在显著差异。在HFpEF患者中，胶原调节的实验室参数关系最多。发现基质金属蛋白酶-9浓度与其他生物标志物之间存在相关性，包括白细胞介素-10（IL-10）（r=0.311；p=0.048）、髓过氧化物酶（r=0.382；p=0.014）、I型前胶原N端前肽（前胶原I N端前肽，PINP）（r=0.722；p<0.001）和III型（r=0.591；p<0.001）、I型前胶原C端前肽（r=0.330；p=0.035）、金属蛋白酶组织抑制剂1型（r=0.410；p=0.00）、EchoCG参数，包括左心房容积指数（LAVI）（r=0.414；p=0.007）和DFRI（r=0.354；p=0.025）。此外，还发现PINP浓度与IL-10（r=0.401；p=0.009）和内皮素-1（r=-0.337；p=0.031）之间存在相关性；PINP与LAVI（r=0.498；p=0.001）和DFRI（r=0.420；p=0.007）之间存在相关性。
HFpEF患者中，胶原稳态紊乱标志物与表征LV FP升高的EchoCG参数之间的关系更多。
