Usefulness of Doppler echocardiography in the diagnosis of congestive heart failure

One hundred fifty-one consecutive patients with a diagnosis of congestive heart failure (CHF) referred for echocardiography were prospectively evaluated to (1) define the frequency of normal left ventricular systolic function in a referral-based population with CHF; (2) establish cardiac mechanisms responsible for symptomatology in these patients; and (3) assess the ability to clinically differentiate these subsets of patients based on routine history and physical examination. Of the 151 total patients, 51 (34%) had normal left ventricular systolic function (left ventricular ejection fraction greater than or equal to 55%). Primary valvular disease was present in 4 of these 51 patients (8%), and Doppler echocardiographic evidence of abnormal left ventricular filling (diastolic dysfunction) was evident in 10 (20%). In addition, no predefined resting abnormality was noted in 34 (66%) of them. Despite this finding, 51% of all patients with normal left ventricular systolic function were being treated with digoxin therapy in the absence of atrial arrhythmia. Clinical differentiation of this group of patients from those with abnormal left ventricular systolic function was difficult and may have accounted for this apparently inappropriate treatment. Thus, evaluation of left ventricular function and of causative mechanisms of CHF before initiation of long-term treatment is mandatory.     

The place of cardiac glycosides in the treatment of chronic heart failure. Part III. The DIG trial

In a series of papers the authors analyze literature data on the use of cardiac glycosides for long term treatment of chronic heart failure. Data obtained in prospective placebo controlled trial DIG show that digoxin significantly increases mortality of all patients with sinus rhythm and intact left ventricular systolic function (ejection fraction > 45%) and of women with left ventricular systolic dysfunction (ejection fraction < or = 45%). Men with left ventricular systolic dysfunction represent the only category of patients with chronic heart failure in sinus rhythm in whom long term administration of digoxin is justified. Digoxin does not affect mortality of these patients however it reduces requirements in hospitalizations due to worsening of heart failure.     

Left ventricular dysfunction induced by monomorphic ventricular arrhythmias: large improvement in ventricular function after radiofrequency ablation of the arrhythmic source

Left ventricular systolic dysfunction related to ventricular arrhythmias is a relatively poorly understood entity. To increase our knowledge base, we describe 5 patients in whom the link between ventricular dysfunction and ventricular arrhythmia was unequivocally established. All patients had repetitive monomorphic ventricular arrhythmias and left ventricular systolic dysfunction (ejection fraction < or =40% and end-diastolic size > or =55 mm). The arrhythmogenic source was identified by electrophysiological study (right ventricle in 2 patients, left ventricle in 2, and left sinus of Valsalva in one), and was eliminated in all patients by radiofrequency catheter ablation. At 7+/-2 months post-ablation, large improvements were seen in left ventricular function and remodeling (ejection fraction >/=50% and end-diastolic size < or =51 mm in all cases), with no recurrence of arrhythmia during follow-up (10-69 months). This finding confirms that recurring ventricular arrhythmias can induce left ventricular dysfunction which may be reversible after ablation.     

Increased circulating levels of ouabain-like factor in patients with asymptomatic left ventricular dysfunction

BACKGROUND: Much evidence has been accumulated that human plasma contains digitalis-like factor(s) with Na/K ATPase inhibitor properties. Increased concentrations of ouabain-like factor (OLF) have been reported in patients with moderate to severe hypertension and in patients with overt congestive heart failure due to dilated cardiomyopathy. AIM: The presence of circulating OLF has not been investigated in borderline to mild hypertension or in the early stage of dilated cardiomyopathy. METHODS AND RESULTS: The study population consisted of 18 normal volunteers, 24 patients with borderline to mild hypertension, 47 patients with asymptomatic left ventricular dysfunction (ALVD) due to dilated cardiomyopathy and 26 patients with cardiac arrhythmias but normal left ventricular function. OLF values (pM ouabain equivalent) were assayed in extracted plasma, using a radioimmunoassay for ouabain. OLF was, respectively, 29.4+/-20.6 pM in normal controls, 39.1+/-23.8 pM in hypertensives, 35+/-18 pM in patients with cardiac arrhythmias, 52.3+/-25.8 pM in ALVD patients not treated with digoxin and 64.6+/-29.6 pM in ALVD patients treated with digoxin. Patients with ALVD, both treated and not treated with digoxin, had OLF significantly higher (P<0.05) than all the other groups. In patients with ALVD no correlation between OLF and left ventricular ejection fraction was observed. In the hypertensive group no correlation between OLF and both diastolic and systolic pressure was found. CONCLUSION: Increased concentrations of OLF were observed in patients with left ventricular dysfunction due to dilated cardiomyopathy, before the occurrence of overt heart failure, suggesting that OLF may be an early marker of the disease.     

Evidence of impaired myocardial perfusion and abnormal left ventricular function during exercise in patients with isolated systolic narrowing of the left anterior descending coronary artery

Seven men ranging in age from 35 to 63 years with a chest pain syndrome and cineangiographically documented systolic narrowing of the left anterior descending coronary artery underwent thallium-201 myocardial scintigraphy and gated cardiac blood pool imaging. Grade II (50 to 75 percent) systolic coronary arterial constriction was present in three patients and grade III constriction (greater than 75 percent) in four. Three of the four patients with grade III constriction had an exercise-induced perfusion abnormality in the thallium-201 scintigram and an impaired left ventricular ejection fraction response during exercise. (In two patients the left ventricular ejection fraction did not change and in one patient it decreased.) Each of the three patients with grade II constriction had normal thallium-201 perfusion and a normal increase in ejection fraction during exercise. These data provide evidence of abnormal myocardial perfusion and impaired left ventricular function during exercise in patients with high grade systolic coronary arterial narrowing.     

Contribution of left ventricular diastolic dysfunction to heart failure regardless of ejection fraction

Heart failure (HF) has been classified as systolic and diastolic based on the left ventricular ejection fraction. We hypothesized that left ventricular diastolic dysfunction is an important element of HF regardless of ejection fraction. Two hundred six patients who had clinical HF were compared with 72 age-matched controls. Diastolic dysfunction, as assessed by the mitral filling pattern and tissue Doppler imaging, was present in >90% of patients who had HF regardless of ejection fraction and was more frequent and severe than in age-matched controls (p <0.001). In patients who had HF, B-type natriuretic peptide correlated with diastolic dysfunction (r = 0.62, p <0.001) but not with ejection fraction or end-diastolic volume index (EDVI). The degree of diastolic dysfunction influenced survival rate (risk ratio 1.64, p <0.05), whereas ejection fraction and EDVI did not. Systolic function measured by systolic mitral annular velocity was decreased in patients who had HF and an ejection fraction /=0.50 (6.6 +/- 1.8 cm/s) compared with control subjects (8.0 +/- 2.1 cm/s, p <0.01). Patients who had HF and an ejection fraction >/=0.50 had an increased ratio of ventricular mass to EDVI. Patients who had HF and an ejection fraction /=0.50 is associated with mild systolic dysfunction and an increased ratio of left ventricular mass to EDVI. In HF with an ejection fraction 相似文献   

Characteristics of a subset of patients with reversible systolic dysfunction in chronic kidney disease

There exists a subgroup of uremic cardiomyopathy patients who experience resolution of heart failure symptoms with recovery of normal cardiac geometry following hemodialysis. The authors studied 52 patients with chronic kidney disease on hemodialysis over a period of 190 days. There were 29 patients with systolic dysfunction (left ventricular ejection fraction <40%). Twenty-three patients with preserved systolic function had diastolic dysfunction. Of the 29 patients with systolic dysfunction, 10 patients had significant improvement in New York Heart Association functional class and left ventricular internal diameter in diastole (LVIDd: 59.8 ± 2.6-55.92 mm and left ventricular internal diameter in systole [LVIDs]: 51.8 ± 1.8-34 ± 1.2 mm; P < .001) with significant increases in left ventricular ejection fraction (30.55%-50.14%; P < .001). These patients had the highest baseline serum levels of troponin I (P = .024), which decreased significantly with recovery of cardiac function. When the entire study group was regrouped as those below and those above the median change of C-reactive protein (CRP), patients with CRP greater than the median change had significant improvements in LVIDs and ejection fraction. A subgroup of patients with uremic cardiomyopathy who demonstrated reversible left ventricular systolic dysfunction had high levels of serum troponin I levels at presentation, which regressed with recovery of ventricular function in parallel with CRP levels.     

Prevalence of Suspected Diastolic Dysfunction in Patients with a Clinical Diagnosis of Congestive Heart Failure

Introduction: The prevalence of diastolic left ventricular (LV) dysfunction in a population presenting with a suspected diagnosis of congestive heart failure (CHF) is questionable and widely variable in the current literature. To minimize the disparity, we evaluated a large echocardiographic database to investigate the prevalence of systolic and suspected diastolic LV dysfunction in those with a suspected clinical diagnosis of CHF. Methods: We retrospectively reviewed echocardiograms performed at our institution and evaluated the prevalence of abnormal LV systolic and diastolic function in those with a suspected clinical diagnosis of CHF. Diastolic dysfunction was defined as the presence of left atrial enlargement, left ventricular hypertrophy and reverse trans-mitral inflow ratio (E/A reversal). Results: Of the 636 echocardiograms with CHF as the primary diagnosis, 461 had measured LV function. Normal LV systolic function were found in 238 of the patients (48%). Isolated diastolic LV dysfunction was found in 166 patients (36%). Twelve percent of the patients with a suspected clinical diagnosis of CHF had normal LV systolic and diastolic function. Conclusion: Normal LV systolic function was seen in nearly one-half of the echocardiograms with a suspected clinical diagnosis of CHF. Suspected LV diastolic dysfunction was observed in one-third of the echocardiograms with a suspected clinical diagnosis of CHF.     

Detection of left ventricular dysfunction in ambulatory subjects with the bedside Valsalva maneuver

The bedside sphygmomanometric determination of the arterial pressure response during the Valsalva maneuver was incorporated into the routine physical examination of ambulatory subjects. Four distinct Valsalva responses were noted: ultrasinusoidal, sinusoidal, absent overshoot, and square wave. The absent overshoot response was further divided into positional and constant types—the latter consistently exhibiting this response regardless of body position. Correlation with resting left ventricular ejection fraction was obtained by radionuclide cineangiography in 200 patients, of whom 81 had left ventricular systolic dysfunction (ejection fraction less than 0.50). Significant differences in the mean left ventricular ejection fraction were found in subjects with an ultrasinusoidal response (0.65 ± 0.11), sinusoidal response (0.55 ± 0.15), constant absent overshoot response (0.37 ± 0.18), and square wave response (0.16 ± 0.04) to Valsalva maneuver. The sensitivity of an abnormal Valsalva response (absent overshoot or square wave responses) for the bedside detection of left ventricular systolic dysfunction was 69 percent, and the predictive value of an ultrasinusoidal Valsalva response for normal ejection fraction was 93 percent. It is concluded that the high predictive accuracy of the Valsalva maneuver makes this simple bedside technique a valuable method for assessing resting left ventricular function.     

Patients With Mild Heart Failure Worsen During Withdrawal From Digoxin Therapy

Objectives. We investigated whether patients with mild heart failure due to left ventricular systolic dysfunction were at risk of worsening during digoxin withdrawal.Background. Deterioration during digoxin withdrawal is often believed to be restricted to patients with moderate to severe clinical evidence of heart failure. To test this hypothesis, we studied the outcome of patients categorized by treatment assignment and a clinical signs and symptoms heart failure score in two rigorously designed clinical heart failure trials: the Prospective Randomized Study of Ventricular Function and Efficacy of Digoxin (PROVED) and the Randomized Assessment of Digoxin and Inhibitors of Angiotensin-Converting Enzyme (RADIANCE) trial.Methods. Potential differences in treatment failure, left ventricular ejection fraction and exercise capacity were evaluated in three groups of patients: those with mild heart failure (score ≤2) who were withdrawn from digoxin (Dig WD Mild); those with moderate heart failure (score >2) who were withdrawn from digoxin (Dig WD Moderate); and patients who continued receiving digoxin regardless of heart failure score (Dig Cont).Results. Heart failure score at randomization did not predict outcome during follow-up in Dig Cont-group patients. Dig WD Mild-group patients were at increased risk of treatment failure and had deterioration of exercise capacity and left ventricular ejection fraction compared with that in Dig Cont-group patients (all p < 0.01). Patients in the Dig WD Moderate group were significantly more likely to experience treatment failure than patients in either the Dig WD Mild or Dig Cont group (both p < 0.05).Conclusions. Patients with systolic left ventricular dysfunction were at risk of clinical deterioration after digoxin withdrawal despite mild clinical evidence of congestive heart failure.(J Am Coll Cardiol 1997;30:42–8)     

Prospective study of left ventricular function after radiofrequency ablation of atrioventricular junction in patients with atrial fibrillation.

BACKGROUND--In patients with drug resistant incessant supraventricular tachycardia, radiofrequency induced ablation of the atrioventricular junction and pacemaker implantation have hitherto been considered a treatment of last resort. OBJECTIVE--To assess the short and long term effects of ablation of the atrioventricular junction on systolic and diastolic left ventricular function in patients with atrial fibrillation with and without impaired left ventricular function. PATIENTS--29 patients (19 men; mean age 65 (SD 7) years (range 50-76)) undergoing ablation of the atrioventricular junction for drug refractory atrial fibrillation were examined a mean of 2, 65, and 216 days after ablation of the bundle of His. MAIN OUTCOME MEASURES--Left ventricular ejection fraction and early filling deceleration times (Edec) were assessed by Doppler echocardiography after 1 to 2 hours of ventricular pacing at a rate of 80 beats/minute. RESULTS--In 14 patients with a left ventricular ejection fraction < 50% left ventricular ejection fraction increased significantly from 32% (11%) to 39% (11%) (65 days) and 45% (11%) (216 days) (P < 0.001); Edec increased from 142 (46) ms to 169 (57) ms (65 days) and 167 (56) ms (216 days) (P < 0.05). In 15 patients with an ejection fraction > or = 50% at the initial examination no significant change in systolic function was observed. CONCLUSIONS--In patients with left ventricular dysfunction long term improvement of systolic and diastolic left ventricular function was seen after ablation of the atrioventricular junction for rate control of atrial fibrillation. This procedure had no adverse effects on normal left ventricular function.     

Effects of discontinuing maintenance digoxin therapy in patients with ischemic heart disease and congestive heart failure in sinus rhythm

To evaluate the importance of oral maintenance digoxin therapy in chronic congestive heart failure (CHF), 24 patients in sinus rhythm on maintenance digoxin for documented CHF were studied prospectively on and off the drug. The average duration of therapy was 39 months (range 2 to 180). All 24 patients had documented coronary artery disease (CAD): 22 were in New York Heart Association functional class III and 2 in class II. Twenty-one patients (88%) were receiving diuretic or vasodilator therapy, or both, before digoxin discontinuance. At 1 month off digoxin and with no increase in doses of other medications excepting minor increases in antianginal therapy in 2 patients, no difference was observed in the group as a whole in symptoms, resting heart rate, arterial blood pressure, physical findings, weight, cardiothoracic ratio, radiographic signs of pulmonary congestion, radionuclide left ventricular ejection fraction (LVEF), duration of symptom-limited treadmill exercise (14 patients), or CHF score, compared with evaluation during maintenance digoxin therapy. Similar results were obtained in a subgroup of 9 patients with a resting LVEF < 0.35 (0.27 ± 0.02; mean ± standard error of the mean). Six patients had a decrease and 5 patients an increase in LVEF of ≥0.05 units after cessation of digoxin. Off digoxin, the CHF score increased by only 1 point in 2 patients, but also decreased in 2 patients. Thus, in this study population comprised of patients with CAD with documented CHF, most of whom were receiving diuretics or vasodilators, or both, digoxin withdrawal had no adverse clinical or hemodynamic effects.     

Review of randomized trials of digoxin therapy in patients with chronic heart failure.

Although digitalis glycosides were introduced in the treatment of cardiac maladies greater than 200 years ago, controversy persists regarding the precise role of digoxin in any multidrug approach to the treatment of congestive heart failure (CHF). Despite its widespread use for more than 2 centuries, only recently have double-blind, randomized, placebo-controlled trials of digoxin therapy been conducted in patients with moderate CHF and sinus rhythm. These trials demonstrate that digoxin is superior to placebo in improving left ventricular (LV) ejection fraction, increasing exercise capacity, and preventing CHF worsening. Digoxin produces benefits similar to those seen with angiotensin converting enzyme (ACE) inhibitors with regard to clinical compensation and improvement in LV function. However, improved survival is demonstrated only in response to ACE inhibitors. The recently completed RADIANCE study addresses the value of combining digoxin with ACE inhibitor therapy in patients with mild-to-moderate CHF. Because increased mortality has been reported with the newer oral inotropic agents, it currently appears that digoxin is the only oral inotropic agent useful in clinical practice in the treatment of CHF. However, the effects of digoxin on mortality in patients with CHF remain unknown. In the large, double-blind, randomized trial conducted by the National Heart, Lung, and Blood Institute, the effects of digoxin on mortality in patients with CHF and already being treated with ACE inhibitors are currently being evaluated. Presently, based on the results of placebo-controlled studies, it appears that digoxin, alone or in combination with ACE inhibitors, is beneficial in patients with any signs or symptoms of CHF due to systolic LV dysfunction.     

Relationship of left atrial appendage function to left ventricular function

BACKGROUND: The study was conducted to evaluate the relationship of left atrial appendage function to left ventricular function and to analyze, if left ventricular dysfunction predisposed to left atrial appendage thrombus formation even in the presence of sinus rhythm. METHODS AND RESULTS: The study was conducted in 78 patients with a mean age of 53+/-8.5 years, all of whom were in sinus rhythm. Transesophageal echocardiography was performed to record the left atrial appendage emptying and filling velocity and to look for the presence of spontaneous echo contrast and thrombus. Patients with severe left ventricular dysfunction (Group I--left ventricular ejection fraction < 35%) and patients with moderate left ventricular dysfunction (Group II--left ventricular ejection fraction 35-45%) had lower left atrial appendage emptying velocity (33.6+/-16 and 39.7+/-19.5 cm/s, respectively) and filling velocity (41+/-14.7 and 41+/-17 cm/s, respectively) when compared to patients with preserved systolic function (Group II--left ventricular ejection fraction >45%), who had emptying and filling velocity of 55+/-16 and 56+/-15 cm/s, respectively (p <0.05). Twelve out of 32 (38%) patients with severe left ventricular dysfunction (Group I) and 7 out of 25 (28%) patients with moderate left ventricular dysfunction (Group II) had presence of left atrial appendage thrombus as compared to none of the patients with preserved left ventricular ejection fraction (Group III) (p <0.001). CONCLUSIONS: Patients with left ventricular dysfunction also had left atrial appendage dysfunction as evidenced by lower emptying and filling velocities and had increased incidence of thrombus formation.     

Relation of atrial natriuretic peptides to left ventricular systolic and diastolic function in heart failure

BACKGROUND: Plasma concentrations of atrial natriuretic peptides are correlated with atrial pressures, as are left ventricular ejection fraction and left ventricular filling abnormalities. AIMS: This study investigated the relation of atrial natriuretic peptides to both left ventricular systolic and diastolic function in heart failure. METHODS: Plasma concentrations of atrial natriuretic peptide and N-terminal pro-atrial natriuretic peptide were measured in 63 patients with chronic heart failure and left ventricular systolic dysfunction. According to Doppler transmitral flow measurements, 19 patients had a restrictive and 44 patients had a non-restrictive left ventricular filling pattern. RESULTS: Plasma concentrations of atrial natriuretic peptide and N-terminal pro-atrial natriuretic peptide were higher in patients with a restrictive filling pattern than in patients with a non-restrictive filling pattern (197 vs. 75 pmol/l, P<0.0001 and 1.14 vs. 0.45 nmol/l, P<0.0001). In univariate analysis, atrial natriuretic peptide and N-terminal pro-atrial natriuretic peptide correlated with deceleration time, E/A ratio and left ventricular ejection fraction. In multivariate analysis, both peptides appeared independently related to left ventricular ejection fraction and left ventricular filling pattern. CONCLUSION: In patients with chronic heart failure, atrial natriuretic peptides provide information on left ventricular systolic as well as diastolic function.     

Mortality and readmission of hospitalized patients with congestive heart failure and preserved versus depressed systolic function

Patients with congestive heart failure (CHF) and preserved systolic function are very common. Despite the high prevalence of this syndrome, very little information is known regarding its mortality and morbidity (e.g., readmission), or the efficacy of drugs. The purpose of this study was to compare the clinical characteristics and prognosis among consecutively hospitalized patients with CHF and preserved versus depressed left ventricular systolic function. Patients with severe aortic or mitral valve disease were excluded from the study. Patients were categorized based on the values of ejection fraction (EF) as having "preserved" (EF>50%), "intermediate" (EF 40% to 50%), or "depressed" (EF<40%) systolic function. Clinical characteristics as well as mortality and hospital readmission rates during 2.4 years of follow-up were recorded for each patient. Sixty-one patients (35%) had preserved systolic function, 73 (43%) had depressed function, and 38 (22%) had intermediate function. Patients with preserved systolic function were more often women and had a higher prevalence of left ventricular hypertrophy (all p <0.05). At follow-up, cumulative survival probabilities were similar between patients with preserved systolic function and those with systolic dysfunction (p = 0.84). Readmission rates were also comparable between preserved and depressed systolic function (36% vs 48%; p = NS). The prognosis of CHF patients with preserved systolic function was similar to those with systolic dysfunction. In light of these findings, effective therapeutic strategy for this subset of patients is needed.     

Hemodynamic effects of noninvasive bilevel positive airway pressure on patients with chronic congestive heart failure with systolic dysfunction

BACKGROUND AND STUDY OBJECTIVES: Noninvasive positive airway pressure may play a significant role in treating patients with congestive heart failure (CHF). We tested our hypothesis that noninvasive bilevel positive airway pressure improves left ventricular performance in patients with chronic CHF secondary to severe systolic dysfunction. OBJECTIVES: To determine the cardiac performance of patients using bilevel positive airway pressure, and to describe the hemodynamic effects of bilevel positive airway pressure and its use as a therapeutic adjunct in these patients. DESIGN: Prospective, cohort, nonrandomized study. SETTING: Outpatient medicine clinic. PATIENTS: Fourteen patients (9 men and 5 women) with stable chronic CHF with left ventricular ejection fraction < or =35%; mean age was 60.6 years (range, 43 to 87 years). INTERVENTIONS: Bilevel positive airway pressure via nasal mask at an inspiratory pressure of 5 cm H(2)O and an expiratory pressure of 3 cm H(2)O on spontaneous mode at room air for 1 h. MEASUREMENTS AND RESULTS: Myocardial performance and changes were measured using clinical and echocardiographic parameters. Baseline clinical and echocardiographic parameters were compared with the same parameters after 1 h of bilevel positive airway pressure. Statistically significant (p<0.05, Wilcoxon matched pair signed-rank test) decreases were noted in these mean values: systolic BP from 136.21 to 124.14 mm Hg (p = 0.008), heart rate from 85.07 to 74.71 beats/min (p = 0.002), respiratory rate from 23.07 to 15.43 breaths/min (p = 0.001), and systemic vascular resistance from 1671. 46 to 1236.27 dyne. s. cm(3) (p = 0.001). Statistically significant increases were noted in these mean values: cardiac output from 5.09 to 6.37 L/min (p = 0.004), ejection fraction from 28.71% to 34.36% (p = 0.001), and end-diastolic volume from 224.36 to 246.21 mL (p = 0.045). CONCLUSION: Bilevel positive airway pressure has excellent potential for improving left ventricular performance of patients with chronic CHF secondary to severe systolic dysfunction.     

社区无症状左心室收缩功能障碍病人的预后

目的：探讨无症状左心室收缩功能障碍病人的预后。方法：从社区每年参加健康体检并经过心脏超声检查的2487名居民中筛选出无症状左心室收缩功能障碍（EF≤50％）92例。左心室收缩功能正常2395例，进行长达12年的随访，观察充血性心力衰竭率及死亡率。评估无症状左心室收缩功能障碍或正常左室收缩功能对充血性心力衰竭发生率或死亡率的影响，用Kaplan--Meier曲线表示，并作对数秩检验。影响预后的因素用Cox风险比例模型鉴定。结果：无症状左心室收缩功能障碍92例，患病率3．7％。无症状左心室收缩功能障碍组随访0．5～12，平均（6．1士3．0）年，检出充血性心力衰竭36例．平均年充血性心力衰竭率6．4％；随访1～12．平均（6．7±2．5）年，检出死亡病人78例，平均年死亡率12．7％。而左心室收缩功能正常组随访1～12，平均（9．4士2．3）年，检出充血性心力衰竭97例，平均年充血性心力衰竭发生率0．4％；随访1～12，平均（9．5±2．2）年，检出死亡病人261例，平均年死亡率1．1％。Kaplan—Meier检验显示两组年充血性心力衰竭率和死亡率均有显著差别（P=0．000）。Cox回归显示无症状左心室收缩功能障碍既是充血性心力衰竭的独立危险因素（HR-6．6，95%．CI3．9～11．1，P=0．000），又是死亡的独立危险因素（HR=5．3，95％CI3．7～7．5，P=0．000）。结论：无症状左心室收缩功能障碍病人充血性心力衰竭率和死亡率较高。     

Evaluation of the patient with congestive heart failure and ventricular arrhythmias

Although vasodilators and new inotropic agents have been shown to improve ventricular function and reduce symptoms, their effect on mortality is uncertain. In view of our failure to reduce mortality in patients with congestive heart failure (CHF), the identification and amelioration of potentially reversible factors that might alter survival are crucial before initiating therapy. The first step is to establish the diagnosis of CHF and the presence or absence of dilated congestive cardiomyopathy. The extent of myocardial dysfunction, both right and left, must also be evaluated. In post-myocardial infarction patients, left ventricular ejection fraction is an important indicator of prognosis during the first 1 to 2 years. However, in patients with chronic CHF and dilated cardiomyopathy, right ventricular ejection fraction may be a more effective predictor of survival. The presence, frequency and complexity of ventricular arrhythmias must be determined, because these arrhythmias may independently increase the risk of sudden cardiac death in patients with ischemic cardiomyopathy. Their role in patients with idiopathic cardiomyopathy is less certain. In addition, myocardial ischemia, left ventricular dyskinesis or aneurysm, occult myocarditis and neurothrombosis formation must be ruled out. Detection and correction of serum electrolyte and neurohumeral abnormalities are essential. Our failure to reduce mortality in patients with CHF may not entirely lie in the lack of effective therapeutic agents but rather in our failure to apply properly the diagnostic and therapeutic approaches now available.     

Intact systolic left ventricular function in clinical congestive heart failure

Clinical congestive heart failure (CHF) is traditionally associated wtih significant left ventricular (LV) systolic dysfunction. Over a 1-year period, 58 patients with CHF and intact systolic function (LV ejection fraction [EF] 62 ± 11%) were identified. An objective clinical-radiographic CHF score was used to document the clinical impression. Based on radionuclide evaluation of peak filling rate, 38 % of these patients were found to have a significant abnormality in diastolic function as measured by peak filling rate (< 2.50 end-diastolic volume/s). An additional 24% of the patients had probable diastolic dysfunction with borderline abnormal peak filling rate measurements (2.5 to 3.0 end-diastolic volume/s). The disease states most frequently associated with CHF and intact systolic function were coronary artery disease and systemic hypertension. During a 3-month sampling period 42% of patients with clinical diagnosis of CHF referred to the nuclear cardiology laboratory were found to have intact systolic function; thus, intact systolic function is not uncommon in patients with clinical CHF. Abnormal diastolic function is the most frequently encountered mechanism for the occurrence of CHF. Definition of systolic and diastolic function appears relevant for development of optimal therapeutic strategies for the treatment of patients with CHF.