Pathophysiological characterization of isolated diastolic heart failure in comparison to systolic heart failure
Pathophysiological characterization of isolated diastolic heart failure in comparison to systolic heart failure
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DOI：
10.1001/jama.288.17.2144
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发表时间：
2002-11-06
影响因子：
120.7
通讯作者：
Stewart, KP
中科院分区：
文献类型：
--
作者：
Kitzman, DW;Little, WC;Stewart, KP
背景许多有充血性心力衰竭症状的老年患者左心室射血分数（LVEF）正常。然而，这种疾病的病理生理学，假定称为舒张性心力衰竭（DHF），目的通过对老年DHF患者进行系统性测量，并与年龄相关性测量结果进行比较，评估经典心力衰竭的4个关键病理生理学特征。匹配的健康志愿者和患有典型收缩性心力衰竭（SHF）的患者。设计和设置观察性临床研究于1998年在温斯顿-塞勒姆，NC的普通社区和教学医院进行。59例有孤立性DHF，定义为临床推定的心力衰竭，LVEF至少为50%，没有明显的冠状动脉、瓣膜或肺部疾病的证据。60例有典型SHF（LVEF ≤ 35%）。28名年龄匹配的健康志愿者controls.Main结果测量左心室结构和功能，运动能力，神经内分泌功能，和quality of life.Results超声心动图，平均（SE）LVEF为60%（2%）的DHF患者与31%（2%）的SHF和54%（2%）的对照组。DHF组左室质量容积比（SE）均值（2.12 [0.14] g/mL）显著高于SHF组（1.22 [0.14] g/mL）（P
Context Many older patients with symptoms of congestive heart failure have a preserved left ventricular ejection fraction (LVEF). However, the pathophysiology of this disorder, presumptively termed diastolic heart failure (DHF), is not well characterized and it is unknown whether it represents true heart failure.Objective To assess the 4 key pathophysiological domains that characterize classic heart failure by systematically performing measurements in older patients with presumed DHF and comparing these results with those from age-matched healthy volunteers and patients with classic systolic heart failure (SHF).Design and Setting Observational clinical investigation conducted in 1998 in a general community and teaching hospital in Winston-Salem, NC.Participants A total of 147 subjects aged at least 60 years. Fifty-nine had isolated DHF defined as clinically presumed heart failure, LVEF of at least 50%, and no evidence of significant coronary, valvular, or pulmonary disease. Sixty had typical SHF (LVEF :less than or equal to35%). Twenty-eight were age-matched healthy volunteer controls.Main Outcome Measures Left ventricular structure and function, exercise capacity, neuroendocrine function, and quality of life.Results By echocardiography, mean (SE) LVEF was 60% (2%) inpatients with DHF vs 31% (2%) in those with SHF and 54% (2%) in controls. Mean (SE) LV mass-volume ratio was markedly increased in patients with DHF (2.12 [0.14] g/mL) vs those with SHF (1.22 [0.14] g/mL) (P