The role of systolic-diastolic coupling in distinguishing impaired diastolic recoil in healthy aging and heart failure with preserved ejection fraction.
The role of systolic-diastolic coupling in distinguishing impaired diastolic recoil in healthy aging and heart failure with preserved ejection fraction.
复制标题
收缩-舒张耦合在区分健康衰老和射血分数保留的心力衰竭中舒张反冲受损中的作用。
DOI：
10.1111/echo.14975
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
Sarma,Satyam
中科院分区：
文献类型：
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作者：
MacNamara,JamesP;Koshti,Vivek;Cheng,I-Jou;Dias,KatrinA;Hearon,ChristopherM;Cornwell3rd,William;Howden,ErinJ;Levine,BenjaminD;Sarma,Satyam
背景：年龄相关的左心室早期舒张后缩变化混淆了e’velocity和保留射血分数（HFpEF）对心力衰竭的诊断价值。收缩期-舒张期耦合量化了被动左心室弹性反弹力，在区分HFpEF患者的异常舒张反弹力与健康衰老方面可能优于e′。本研究旨在确定健康老化和HFpEF对收缩期-舒张期耦合的影响。方法健康成人（141例，年龄20 ~ 90岁）行右心导管术（RHC）量化左室充血压力，组织多普勒超声心动图确定二尖瓣环的峰值速度和偏移（速度时间积分）。另外，HFpEF患者（n = 12，年龄67±5岁）和对照组（n = 12，年龄68±5岁）分别行RHC和超声心动图检查。收缩期-舒张期耦合测量为早期舒张期偏移（EDexc）除以收缩期偏移（Sexc）。结果健康成人EDexc/ sex每10年下降15% （r2= 0.53，P< 0.001）。与对照组相比，HFpEF组EDexc/ sexc显著降低（0.43±0.11 vs 0.56±0.11，P= 0.011）， EDexc/ sexc与对照组相似（6.2±1.5 vs 6.8±1.3 cm/s，P= 0.33）。采用ROC分析，EDexc/Sexchad和AUC检测HFpEF为0.82(0.61‐0.95，P= .007)，优于单独使用EDexc (AUC 0.60(0.39‐0.80)，P= .39；P= 0.026)。结论EDexc/Sexcratio量化的收缩-舒张耦合随着健康年龄的增长呈线性下降。EDexc/Sexcratio在HFpEF中进一步降低，能够比单独EDexc/Sexcratio更准确地预测HFpEF。收缩期-舒张期耦合可能是检测HFpEF的有用诊断工具。
BackgroundAge‐related changes to left ventricular (LV) early diastolic recoil confound the diagnostic value of e′ velocity in heart failure with preserved ejection fraction (HFpEF). Systolic–diastolic coupling quantifies passive left ventricular elastic recoil and may be superior to e′ in differentiating abnormal diastolic recoil in HFpEF from healthy aging. This study aims to determine the effect of healthy aging and HFpEF on systolic–diastolic coupling.MethodsHealthy adults (n = 141, aged 20‐90 years) underwent right heart catheterization (RHC) to quantify LV filling pressure and tissue Doppler echocardiography to define peak velocities and excursion (velocity time integral) of the mitral annulus. Separately, HFpEF patients (n = 12, age 67 ± 5 years) and controls (n = 12, age 68 ± 5 years) underwent RHC and echocardiography. Systolic–diastolic coupling was measured as early diastolic excursion (EDexc) divided by systolic excursion (Sexc).ResultsIn healthy adults, EDexc/ Sexcdeclined by 15% per decade of life (r2= 0.53,P< .001). EDexc/Sexcwas significantly lower in HFpEF compared with controls (0.43 ± 0.11 vs 0.56 ± 0.11,P= .011), while e′ was similar (6.2 ± 1.5 vs 6.8 ± 1.3 cm/s,P= .33). Using ROC analysis, EDexc/Sexchad an AUC to detect HFpEF of 0.82 (0.61‐0.95,P= .007), which was superior to e′ alone (AUC 0.60(0.39‐0.80),P= .39;P= .026 for difference).ConclusionsSystolic–diastolic coupling, quantified by the EDexc/Sexcratio, declined linearly with healthy aging. The EDexc/Sexcratio was further reduced in HFpEF and able to predict HFpEF more accurately than e′ alone. Systolic–diastolic coupling may be a useful diagnostic tool to detect HFpEF.