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《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:

2015年第5期

页码:

588-591

栏目:

临床研究

出版日期:

2015-05-05

文章信息/Info

Title:

Differences and similarities in left ventricular structures and left ventricular systolic functions between heart failure patients with preserved or reduced ejection fraction

作者:

边长勇¹; 尹宗宪¹; 李 涛¹; 胡燕华¹; 何丽红¹; 刘 新¹; 李方都²

（上海利群医院：1.心内科，2.核医学科，上海 200333）

Author(s):

BIAN Chang-yong¹;  YIN Zong-xian¹;  LI Tao¹;  HU Yan-hua¹;  HE Li-hong¹;  LIU Xin¹;  LI Fang-dou²

(1.Department of Cardiology, 2.Department of Nuclear Medicine, Liqun Hospital, Shanghai 200333, China)

关键词:

心力衰竭; 射血分数保留; 射血分数降低; 超声心动图; 核素心室显像; 收缩功能储备; 预后

Keywords:

heart failure;  preserved ejection fraction;  reduced ejection fraction;  echocardiograghy;  radionuclide ventriculography;  left ventricular systolic function reserve;  prognosis

分类号:

R541.6

DOI:

-

文献标识码:

A

摘要:

目的 探讨射血分数保留充血性心力衰竭(HFpEF)与射血分数降低充血性心力衰竭(HFrEF)患者的左室结构和左室收缩功能的变化。方法 入选HFpEF及HFrEF患者各40例。入组者行超声心动图检查。经核素心血池显像测定分级小剂量多巴酚丁胺负荷后心率（HR）及左室收缩功能指标左室射血分数（LVEF）、高峰射血率（PER）、高峰射血时间（TPER）最大变化率。比较HFpEF及HFrEF患者6个月预后，观测HFpEF患者6个月后LVEF变化。结果 HFpEF组患者左房内径（LAD）、左室收缩期末内径（LVESD）、左室舒张期末内径（LVEDD）显著小于HFrEF组（均P<0.05）；HFpEF组患者室间隔厚度（IVST）、左室后壁厚度(LVPWT)大于HFrEF组（P<0.05）；HFpEF组LVEF在静息及各负荷值较HFrEF组高（P<0.05），但LVEF最大变化率与HFrEF组比较无统计学意义。两组间PER最大变化率及TPER最大变化率比较无统计学意义。两组6个月内病死率无显著差异。HFpEF组6个月后存活患者有3例LVEF低于50%，发生率为9%。 结论 两组左房室结构存在明显差异，HFrEF组静息LVEF明显低于HFpEF组，但两组左室收缩功能储备基本一致，部分HFpEF患者可演变为HFrEF患者。

Abstract:

AIM To investigate the similarities and differences in left ventricular structures and left ventricular systolic functions between heart failure patients with preserved ejection fraction (HFpEF) or reduced ejection fraction (HFrEF). METHODS Forty HFpEF patients and 40 HFrEF patients were included in the study. Echocardiograghy was performed. Left ventricular systolic function indices including left ventricular ejection fraction (LVEF), peak ejection rate (PER) and peak ejection time (TPER) were measured using radionuclide ventriculography under resting condition and dobutamine stress. The maximal change rate (MCR) of HR, LVEF, PER and TPER were calculated. The 6-month mortality rate in HFpEF patients and HFrEF patients was recorded. LVEF in survivors of HFpEF patients was measured after 6 months. RESULTS LAD, LVESD and LVEDD in HFpEF patients were much lower than in HFrEF patients (P<0.05). IVST and LVPWT in HFpEF patients were higher than in HFrEF patients (P<0.05). LVEF at rest and dobutamine stress in HFpEF patients was higher than in HFrEF patients (P<0.05). There were no significant differences in MCR of LVEF, PER, TPER and 6-month mortality rate between groups. Three out of 34 (9%) survivors with HFpEF developed HFrEF in 6 months. CONCLUSION Significant difference in left atrial and ventricular structures is observed between HFpEF patients and HFrEF patients. LVEF at rest and stress in HFpEF patients was higher than in HFrEF patients. There is no significant difference in contractile reserve. Some HFpEF patients may develop HFrEF.

参考文献/References

[1]Owan TE,Hodge DO,Herges RM,et al.Trends in prevalence and outcome of heart failure with preserved ejection fraction[J].N Engl J Med,2008,355(3):251-259.
[2]Oktay AA,Rich JD,Shah SJ.The emerging epidemic of heart failure with preserved ejection fraction[J].Curr Heart Fail Rep,2013,10(4):401-410.
[3]Dickstein K,Cohen-Solal A,Filippatos G,et al.ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008.The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure.2008 of the European Society of Cardiology.Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine(ESICM)[J].Eur J Heart Fail,2008,10(10):933-989.
[4]Zhou J,Shi H,Zhang J,et al.Rationale and design of the β-blocker in heart failure with normal left ventricular ejection fraction(β-PRESERVE)study[J].Eur J Heart Fail,2010,12(2):181-185.
[5]Yancy CW,Lopatin M,Stevenson LW,et al.Clinical presentation,management, and inhospital outcomes of patients admitted with acute decompensated heart failure with preserved systolic function: a report from the Acute Decompensated Heart Failure National Registry(ADHERE)Data-base[J].J Am Coll Cardiol,2006,47(1):76-84.
[6]Shah SJ.Evolving approaches to the management of heart failure with preserved ejection fraction in patients with coronary artery disease[J].Curr Treat Options Cardiovasc Med,2010,12(1):58-75.
[7]Van Veldhuisen DJ,Linssen GC,Jaaarsma T,et al.B-type natriuretic peptide and prognosis in heart failure patients with preserved and reduced ejection fraction[J].J Am Coll Cardiol,2013,61(14):1498-1506.
[8]Shah AM,Solomon SD.Myocardial deformation imaging: Current status and future directions[J].Circulation,2012,125(1):244-248.
[9]Vinereanu D,Nicolaides E,Tweddel AC,et al.“Pure” diastolic dysfunction is associated with 1ong-axis systolic dysfunction. implications for the diagnosis and classification of heart failure[J].Eur J Heart Fail,2005,7(5):820-828.
[10]Jaroslav M.The role of exercise echocardiography in the diagnostics of heart failure with normal left ventricular ejection fraction[J].Eur J Echocardiogr,2011,12(8):591-602.
[11]赵 威，李学宇，崔 鸣，等.增益指数与原发性高血压左室肥厚及心功能相关性研究[J].中国实用内科杂志,2011,31(9):710-712.
[12]Borlaug BA,Olson TP,Lam CS,et al.Global cardiovascular reserve dysfunction in heart failure with preserved ejection fraction[J].J Am Coll Cardiol,2010,56(1):845-854.
[13]Fonarow GC,Stough WG,Abraham WT,et al.Characteristics, treatments,and outcomes of patients with preserved systolic function hospitalized for heart failure:a report from the OPTIMIZE-HF Registry[J].J Am Coll Cardiol,2007,50(8):768-777.
[14]Steinberg BA,Zhao X,Heidenreich PA,et al.Trends in patients hospitalized with heart failure and preserved left ventricular ejection fraction: prevalence,therapies,and outcomes[J].Circulation,2012,126(1):65-75.

备注/Memo

备注/Memo:

收稿日期：2014-12-02.
作者简介：边长勇，副主任医师，硕士 Email：chybian@163.com

常用功能

更新日期/Last Update: 2015-04-28