Patterns of structural and functional remodeling of the left ventricle in chronic heart failure
Patterns of structural and functional remodeling of the left ventricle in chronic heart failure
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DOI：
10.1016/j.amjcard.2008.03.081
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发表时间：
2008-08-15
影响因子：
2.8
通讯作者：
Zile, Michael R.
中科院分区：
文献类型：
--
作者：
Gaasch, William H.;Delorey, Dennis E.;Zile, Michael R.
心力衰竭患者在左心室（LV）体积、质量和功能方面表现出各种各样的改变。本研究的目的是确定左室结构和功能重构的常见模式，并考虑其在慢性心力衰竭患者中的临床意义。在一项涉及慢性心力衰竭患者（n = 315）的研究筛选阶段获得的二维超声心动图用于计算左室容积、质量、几何形状和射血分数（EF）。纳入需要诊断心衰的有症状的患者接受药物治疗。测量左室大小或功能不作为纳入或排除标准。EF与左室舒张末期容积（EDV）呈反曲线关系，可以描述4种重构模式。模式A （n = 66）定义为正常EDV （< 91 ml/m(2)）和正常EF (>= 50%)；65%的患者表现为左室肥大或同心重构。模式B （n = 65）定义为EDV正常，EF下降；63%存在肥大或同心重构。模式C （n = 175）定义为EDV升高，EF降低；94%的患者存在偏心肥厚。模式D （n = 9）定义为EDV升高，EF正常；88%存在偏心肥厚。总之，这些重塑模式包括广泛的几何变化，具有不同的临床和病理生理特征，可能有不同的治疗策略。(C) 2008爱思唯尔公司版权所有。
Patients with heart failure show a wide variety of alterations in left ventricular (LV) volume, mass, and function. The purpose of this study was to define the common patterns of LV structural and functional remodeling and consider their clinical implications in patients with chronic heart failure. Two-dimensional echocardiograms obtained during the screening phase of a study involving patients (n = 315) with chronic heart failure were used to calculate LV volume, mass, geometry, and ejection fraction (EF). Inclusion required the diagnosis of heart failure in symptomatic patients on medical therapy. Measures of LV size or function were not used as inclusion or exclusion criteria. Plots of EF against LV end-diastolic volume (EDV) showing an inverse curvilinear relation allowed a description of 4 remodeling patterns. Pattern A (n = 66) was defined as normal EDV (< 91 ml/m(2)) and normal EF (>= 50%); 65% of these patients showed LV hypertrophy or concentric remodeling. Pattern B (n = 65) was defined as normal EDV and depressed EF; hypertrophy or concentric remodeling was present in 63%. Pattern C (n = 175) was defined as increased EDV and depressed EF; eccentric hypertrophy was present in 94%. Pattern D (n = 9) was defined as increased EDV and normal EF; eccentric hypertrophy was present in 88%. In conclusion, these patterns of remodeling encompass a wide spectrum of geometric changes with different clinical and pathophysiologic features and possibly different management strategies. (C) 2008 Elsevier Inc. All rights reserved.