Diastolic heart failure can be diagnosed by comprehensive two-dimensional and Doppler echocardiography
Diastolic heart failure can be diagnosed by comprehensive two-dimensional and Doppler echocardiography
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DOI：
10.1016/j.jacc.2005.09.032
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发表时间：
2006-02-07
影响因子：
24
通讯作者：
Little, WC
中科院分区：
文献类型：
--
作者：
Oh, JK;Hatle, L;Little, WC
有许多心肌和非心肌疾病导致心力衰竭，左心室射血分数（LVEF）正常。其中，舒张性心力衰竭（舒张功能障碍所致心力衰竭）是LVEF正常的心力衰竭最常见的原因。舒张性心力衰竭可通过全面的二维和多普勒超声心动图轻易诊断，其可在正常LV尺寸和保留LVEF的情况下显示异常心肌舒张、顺应性降低和充盈压增加。因此，在有心力衰竭临床证据的患者中，当二维超声心动图显示LVEF正常时，应始终考虑舒张性心力衰竭。如果多普勒超声心动图和心肌组织成像提供心肌舒张受损的证据（即，早期舒张期间初始瓣环的纵向速度降低和二尖瓣流入的传播速度降低）、顺应性降低（二尖瓣A波持续时间缩短和二尖瓣减速时间）和充盈压增加（等容舒张时间缩短和舒张早期二尖瓣和二尖瓣环速度之间的比率增加）。通过使用超声心动图早期识别无症状患者的舒张功能障碍可能提供一个机会，以管理潜在的病因，以防止进展为舒张性心力衰竭。
There are many myocardial and non-myocardial conditions that cause heart failure with normal left ventricular ejection fraction (LVEF). Among them, diastolic heart failure (heart failure due to diastolic dysfunction) is the most common cause of heart failure with normal LVEF. Diastolic heart failure easily can be diagnosed by comprehensive two-dimensional and Doppler echocardiography, which can demonstrate abnormal myocardial relaxation, decreased compliance, and increased filling pressure in the setting of normal LV dimensions and preserved LVEF. Therefore, diastolic heart failure should always be considered when LVEF is normal on two-dimensional echocardiography in patients with clinical evidence of heart failure. The diagnosis can be confirmed if Doppler echocardiography and myocardial tissue imaging provide evidence for impaired myocardial relaxation (i.e., decreased longitudinal velocity of the initial annulus during early diastole and decreased propagation velocity mitral inflow), decreased compliance (shortened mitral A-wave duration and mitral deceleration time), and increased filling pressure (shortened isovolumic relaxation time and an increased ratio between early diastolic mitral and mitral annular velocities). Early identification of diastolic dysfunction in asymptomatic patients by the use of echocardiography may provide an opportunity to manage the underlying etiology to prevent progression to diastolic heart failure.