Diastolic dysfunction in heart failure with preserved systolic function:: Need for objective evidence -: Results from the CHARM echocardiographic Substudy CHARMES
Diastolic dysfunction in heart failure with preserved systolic function:: Need for objective evidence -: Results from the CHARM echocardiographic Substudy CHARMES
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DOI：
10.1016/j.jacc.2006.08.062
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发表时间：
2007-02-13
影响因子：
24
通讯作者：
McKelvie, Robert S.
中科院分区：
文献类型：
--
作者：
Persson, Hans;Lonn, Eva;McKelvie, Robert S.
目的：我们检验了舒张功能障碍（DD）是心血管（CV）死亡或心力衰竭（HF）住院治疗的重要预测因子的假设超过40%的HF住院患者具有保留的收缩功能（HF-PSF），提示DD可能是HF临床表现的原因。方法患者在随机接受坎地沙坦或安慰剂治疗后≥ 14个月接受多普勒超声心动图检查，包括肺静脉血流评估或血浆NT-脑钠肽前体测定。结果共312例患者，平均年龄66 ± 11岁，EF为50 ± 10%，女性占34%。中位随访时间为18.7个月。在67%的分类患者（n = 293）中发现舒张功能障碍，44%的患者发现中度和重度DD。中度和重度DD与正常和轻度DD相比预后较差（18% vs.5%，p < 0.01）。舒张功能障碍、年龄、糖尿病、既往HF和房颤是预后的单变量预测因素。在多变量分析中，中度（风险比[HR] 3.7，95%置信区间[CI] 1.2至11.1）和重度DD（HR 5.7，95% CI 1.4至24.0）仍然是唯一的独立预测因子（p = 0.003）。中度和重度DD（少于一半的患者）是不良结局的重要预测因素。结果表明，HF-PSF患者DD的预后意义和客观证据的需要。
Objectives We tested the hypothesis that diastolic dysfunction (DD) was an important predictor of cardiovascular (CV) death or heart failure (HF) hospitalization in a subset of patients (ejection fraction [EF] > 40%) in the CHARM-Preserved study.Background More than 40% of hospitalized patients with HF have preserved systolic function (HF-PSF), suggesting that DD may be responsible for the clinical manifestations of HF.Methods Patients underwent Doppler echocardiographic examination that included assessment of pulmonary venous flow or determination of plasma NT-pro-brain natriuretic peptide >= 14 months after randomization to candesartan or placebo. The patients were classified into 1 of 4 diastolic function groups: normal, relaxation abnormality (mild dysfunction), pseudonormal (moderate dysfunction), and restrictive (severe dysfunction).Results There were 312 patients in the study, mean age was 66 +/- 11 years, EF was 50 +/- 10%, and 34% were women. The median follow-up was 18.7 months. Diastolic dysfunction was found in 67% of classified patients (n = 293), and moderate and severe DD were identified in 44%. Moderate and severe DD had a poor outcome compared with normal and mild DD (18% vs. 5%, p < 0.01). Diastolic dysfunction, age, diabetes, previous HF, and atrial fibrillation were univariate predictors of outcome. In multivariate analysis, moderate (hazard ratio [HR] 3.7, 95% confidence interval [CI] 1.2 to 11.1) and severe DD (HR 5.7, 95% CI 1.4 to 24.0) remained the only independent predictors (p = 0.003).Conclusions Objective evidence of DD was found in two-thirds of HF-PSF patients. Moderate and severe DD, which were found in less than one-half of the patients, were important predictors of adverse outcome. The results demonstrate the prognostic significance and need for objective evidence of DD in HF-PSF patients.