Diastolic heart failure - Abnormalities in active relaxation and passive stiffness of the left ventricle
Diastolic heart failure - Abnormalities in active relaxation and passive stiffness of the left ventricle
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DOI：
10.1056/nejmoa032566
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发表时间：
2004-05-06
影响因子：
158.5
通讯作者：
Gaasch, WH
中科院分区：
文献类型：
--
作者：
Zile, MR;Baicu, CF;Gaasch, WH
背景技术具有心力衰竭体征和症状且左心室射血分数正常的患者被认为患有舒张性心力衰竭。传统上认为这些患者心力衰竭的病理生理原因是左心室舒张特性异常。然而，这一假设在很大程度上尚未得到证实。 方法 我们前瞻性地筛选了 47 名符合明确舒张性心力衰竭诊断标准的患者；所有患者都有心力衰竭的体征和症状，射血分数正常，左心室舒张末压升高。十名没有心血管疾病证据的患者作为对照。通过心导管检查和超声心动图评估左心室舒张功能。结果舒张性心力衰竭患者左心室舒张异常，左心室硬度增加。舒张性心力衰竭组的等容压下降 (tau) 平均 (+/-SD) 时间常数比对照组长（59+/-14 毫秒 vs. 35+/-10 毫秒，P = 0.01）。与对照组相比，舒张性心力衰竭患者的舒张压-容量关系向上并向左移动。舒张性心力衰竭组的校正后左心室被动僵硬度常数显着高于对照组（0.03±0.01 vs. 0.01±0.01，P<0.001）。结论射血分数正常的心力衰竭患者在主动舒张和被动僵硬方面有显着异常。在这些患者中，舒张压升高和心力衰竭的病理生理原因是舒张功能异常。
BACKGROUNDPatients with signs and symptoms of heart failure and a normal left ventricular ejection fraction are said to have diastolic heart failure. It has traditionally been thought that the pathophysiological cause of heart failure in these patients is an abnormality in the diastolic properties of the left ventricle; however, this hypothesis remains largely unproven.METHODSWe prospectively identified 47 patients who met the diagnostic criteria for definite diastolic heart failure; all the patients had signs and symptoms of heart failure, a normal ejection fraction, and an increased left ventricular end-diastolic pressure. Ten patients who had no evidence of cardiovascular disease served as controls. Left ventricular diastolic function was assessed by means of cardiac catheterization and echocardiography.RESULTSThe patients with diastolic heart failure had abnormal left ventricular relaxation and increased left ventricular chamber stiffness. The mean ( +/- SD) time constant for the isovolumic-pressure decline (tau) was longer in the group with diastolic heart failure than in the control group ( 59 +/- 14 msec vs. 35 +/- 10 msec, P = 0.01). The diastolic pressure - volume relation was shifted up and to the left in the patients with diastolic heart failure as compared with the controls. The corrected left ventricular passive-stiffness constant was significantly higher in the group with diastolic heart failure than in the control group (0.03 +/- 0.01 vs. 0.01 +/- 0.01, P< 0.001).CONCLUSIONSPatients with heart failure and a normal ejection fraction have significant abnormalities in active relaxation and passive stiffness. In these patients, the pathophysiological cause of elevated diastolic pressures and heart failure is abnormal diastolic function.