van Ommen A M L N, Bear L R, Sampedrano C Carlos, Onland-Moret N C, Cramer M J, Rutten F H, Canto E Dal, Tulevski I I, Somsen G A, Sweitzer N K, Coronel R, den Ruijter H M
Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Univ. Bordeaux, INSERM, CRCTB, IHU Liryc, Bordeaux, 1045, F-33000, France.
BMC Cardiovasc Disord. 2025 May 30;25(1):417. doi: 10.1186/s12872-025-04879-2.
Women are prone to develop heart failure with preserved ejection fraction (HFpEF) and have a longer QT interval compared to men at comparable heart rates, which results in shorter electrical and mechanical diastole. We hypothesize that a shorter electrical diastole increases HFpEF risk, independent of heart rate.
In 85,145 women and men visiting the Cardiology Centers of the Netherlands between 2007 and 2018, we calculated electrical diastolic intervals (TQ and TP) by subtracting the QT interval, or the sum of the QT- and PQ intervals, respectively, from the RR interval using 12-lead ECG recordings. Electrical diastolic intervals were compared between patients with prevalent left ventricular diastolic dysfunction (LVDD), HFpEF and controls. We validated the TQ interval's association with diastolic function using right atrial pacing and sotalol infusion in a pig model (n = 6).
TQ intervals were approximately 30 ms shorter in women than men. Patients with LVDD or HFpEF had shorter TQ intervals compared to controls (LVDD: 479 ± 128ms, HFpEF: 485 ± 138ms and controls: 523 ± 137ms). Shorter TQ intervals increased the risk of prevalent LVDD/HFpEF (per SD decrease in TQ: OR = 1.37, 95%CI: 1.28, 1.45 and 1.16, 95%CI: 1.01, 1.35, respectively) in fully adjusted models in both sexes. After a median follow-up of 8 [IQR = 6-10] years, shorter TQ intervals were associated with a significant higher risk of death (HR = 1.13, 95%CI:1.02, 1.25) in patients with LVDD and HFpEF. In the subgroup with "delayed relaxation", beta-blocker use was associated with a significantly lower risk of death, which was not observed in those with "stiff" ventricles showing pseudonormalization or restrictive inflow patterns. Findings were independent of heart rate, and not exclusive to women. In pigs, paced at 100 bpm, sotalol infusion decreased the TQ interval, and TQ shortening was correlated to decreasing e'/a' ratio (r = 0.371, p = 0.018) and E/A ratio (r = 0.337, p = 0.030).
A short electrical diastole is associated with a higher risk of prevalent LVDD and HFpEF in both women and men at cardiovascular risk, independent of heart rate. Experimental shortening of the electrical diastole induced functional diastolic abnormalities in pigs. This overlooked mechanism of electrical diastolic shortening may contribute to the complex HFpEF syndrome, with beta-blockers potentially benefiting selected groups.
Not applicable.
与男性相比，女性更容易发生射血分数保留的心力衰竭（HFpEF），并且在心率相当的情况下，女性的QT间期更长，这导致电舒张期和机械舒张期更短。我们假设，独立于心率之外，较短的电舒张期会增加HFpEF风险。
在2007年至2018年间前往荷兰心脏病中心就诊的85145名女性和男性中，我们使用12导联心电图记录，通过从RR间期分别减去QT间期或QT间期与PQ间期之和来计算电舒张间期（TQ和TP）。比较了患有左心室舒张功能障碍（LVDD）、HFpEF的患者与对照组之间的电舒张间期。我们在猪模型（n = 6）中使用右心房起搏和索他洛尔输注验证了TQ间期与舒张功能的关联。
女性的TQ间期比男性短约30毫秒。与对照组相比，LVDD或HFpEF患者的TQ间期更短（LVDD：479±128毫秒，HFpEF：485±138毫秒，对照组：523±137毫秒）。在完全调整模型中，较短的TQ间期增加了男女两性患LVDD/HFpEF的风险（TQ每降低一个标准差：OR = 1.37，95%CI：1.28，1.45；OR = 1.16，95%CI：1.01，1.35）。在中位随访8 [IQR = 6 - 10]年后，较短的TQ间期与LVDD和HFpEF患者的死亡风险显著升高相关（HR = 1.13，95%CI：1.02，1.25）。在“舒张延迟”亚组中，使用β受体阻滞剂与死亡风险显著降低相关，而在表现为假性正常化或限制性流入模式的“僵硬”心室患者中未观察到这种情况。研究结果独立于心率，并非女性所特有。在猪中，以100次/分钟起搏，输注索他洛尔可缩短TQ间期，TQ缩短与e'/a'比值降低（r = 0.371，p = 0.018）和E/A比值降低（r = 0.337，p = 0.030）相关。
对于有心血管风险的女性和男性，短电舒张期与患LVDD和HFpEF的较高风险相关，且独立于心率。实验性缩短电舒张期可在猪中诱发功能性舒张异常。这种被忽视的电舒张期缩短机制可能导致复杂的HFpEF综合征，β受体阻滞剂可能使特定群体受益。
不适用。
