Impaired systolic function by strain imaging in heart failure with preserved ejection fraction.
Impaired systolic function by strain imaging in heart failure with preserved ejection fraction.
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DOI：
10.1016/j.jacc.2013.09.052
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发表时间：
2014-02-11
影响因子：
24
通讯作者：
PARAMOUNT Investigators
中科院分区：
文献类型：
--
作者：
Kraigher-Krainer E;Shah AM;Gupta DK;Santos A;Claggett B;Pieske B;Zile MR;Voors AA;Lefkowitz MP;Packer M;McMurray JJ;Solomon SD;PARAMOUNT Investigators
本研究旨在确定射血分数保留心力衰竭（HFpEF）中收缩变形受损的频率和幅度。虽然舒张功能障碍被广泛认为是HFpEF的一个关键病理生理介质，但伴随的收缩功能障碍的患病率尚未明确定义。我们评估了219例来自同期HFpEF临床试验的HFpEF患者的心肌收缩和舒张功能。使用供应商独立的二维斑点追踪软件评估心肌变形。评估HFpEF中受损变形的频率和严重程度，并与50例无心血管疾病的正常对照组和44例年龄和性别匹配的舒张功能障碍（高血压心脏病）但无HF的高血压患者进行比较。在HFpEF患者中，确定了左心室应变的临床、超声心动图和生物标志物相关性。HFpEF患者的左心室射血分数和舒张功能障碍的证据。与正常对照组和高血压性心脏病患者相比，HFpEF患者的纵向应变（LS）显著降低（分别为−20.0 ± 2.1和−17.07 ± 2.04 vs. −14.6 ± 3.3，p < 0.0001）和周向应变（CS）（分别为−27.1 ± 3.1和−30.1 ± 3.5对−22.9 ± 5.9; p < 0.0001）。在HFpEF中，LS和CS均与LVEF相关（LS，R =-0.46; p < 0.0001; CS，R =-0.51; p < 0.0001），但与舒张功能的标准超声心动图测量值（E'或E/E'）无关。LS较低与NT-proBNP较高中度相关，即使在校正了10个基线协变量（包括LVEF、舒张功能指标和LV充盈压）后也是如此（多变量校正p = 0.001）。尽管HFpEF患者的整体LVEF保持不变，但应变成像可检测到收缩功能受损，这可能有助于HFpEF综合征的病理生理学。（LCZ 696与缬沙坦在慢性心力衰竭和左心室射血分数保留患者中的比较; NCT 00887588）（J Am科尔Cardiol 2014;63：447-56）© 2014美国心脏病学会基金会
This study sought to determine the frequency and magnitude of impaired systolic deformation in heart failure with preserved ejection fraction (HFpEF). Although diastolic dysfunction is widely considered a key pathophysiologic mediator of HFpEF, the prevalence of concomitant systolic dysfunction has not been clearly defined. We assessed myocardial systolic and diastolic function in 219 HFpEF patients from a contemporary HFpEF clinical trial. Myocardial deformation was assessed using a vendor-independent 2-dimensional speckle-tracking software. The frequency and severity of impaired deformation was assessed in HFpEF, and compared to 50 normal controls free of cardiovascular disease and to 44 age- and sex-matched hypertensive patients with diastolic dysfunction (hypertensive heart disease) but no HF. Among HFpEF patients, clinical, echocardiographic, and biomarker correlates of left ventricular strain were determined. The HFpEF patients had preserved left ventricular ejection fraction and evidence of diastolic dysfunction. Compared to both normal controls and hypertensive heart disease patients, the HFpEF patients demonstrated significantly lower longitudinal strain (LS) (−20.0 ± 2.1 and −17.07 ± 2.04 vs. −14.6 ± 3.3, respectively, p < 0.0001 for both) and circumferential strain (CS) (−27.1 ± 3.1 and −30.1 ± 3.5 vs. −22.9 ± 5.9, respectively; p < 0.0001 for both). In HFpEF, both LS and CS were related to LVEF (LS, R = −0.46; p < 0.0001; CS, R = −0.51; p < 0.0001) but not to standard echocardiographic measures of diastolic function (E’ or E/E’). Lower LS was modestly associated with higher NT-proBNP, even after adjustment for 10 baseline covariates including LVEF, measures of diastolic function, and LV filling pressure (multivariable adjusted p = 0.001). Strain imaging detects impaired systolic function despite preserved global LVEF in HFpEF that may contribute to the pathophysiology of the HFpEF syndrome. (LCZ696 Compared to Valsartan in Patients With Chronic Heart Failure and Preserved Left-ventricular Ejection Fraction; NCT00887588) (J Am Coll Cardiol 2014;63:447–56) © 2014 by the American College of Cardiology Foundation
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影响因子：
6
作者：
Fang, ZY;Leano, R;Marwick, TH
通讯作者：
Marwick, TH
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DOI：
10.1111/j.1540-8175.2011.01410.x
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2011-07-01
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