Cardiac structure and function and dependency in the oldest old

OBJECTIVES: To examine the association between cardiac function and activities of daily living (ADLs) in an age‐homogenous, community‐dwelling population born in 1920 and 1921. DESIGN: Cross‐sectional analysis of a prospective cohort study. SETTING: Community‐dwelling elderly population. PARTICIPANTS: Participants were recruited from the Jerusalem Longitudinal Cohort Study, which has followed an age‐homogenous cohort of Jerusalem residents born in 1920 and 1921. Four hundred eighty‐nine of the participants (228 male, 261 female) from the most recent set of data collection in 2005 and 2006 underwent echocardiography at their place of residence in addition to structured interviews and physical examination. MEASUREMENTS: A home‐based comprehensive assessment was performed to assess health and functional status, including performance of ADLs. Dependence was defined as needing assistance with one or more basic ADLs. Standard echocardiographic assessment of cardiac structure and function, including ejection fraction (EF) and diastolic function as assessed using early diastolic mitral annular tissue velocity measurements obtained using tissue Doppler, was performed. RESULTS: Of the participants with limitation in at least one ADL, significantly more had low EF (<55%) than the group that was independent (52.6 % vs 39.1%; P=.01). In addition, participants with dependence in ADL had higher left ventricular mass index (LVMI) (129.3 vs 119.7 g/m²) and left atrial volume index (LAVI) (41.3 vs 36.7 mL/m²). There were no differences between the groups in percentage of participants with impaired diastolic function or average ratio of early diastolic transmitral flow velocity to early diastolic mitral annular tissue velocity (11.5 vs 11.8; P=.64). CONCLUSION: In this age‐homogenous cohort of the oldest old, high LVMI and LAVI and indices of systolic but not diastolic function as assessed according to Doppler were associated with limitations in ADLs.     

Cardiac function as assessed by echocardiography in the oldest old > or = 90 years of age

Although several studies have demonstrated that cardiac diastolic function is impaired but cardiac systolic function is preserved with aging, no large-scale analysis of cardiac function by echocardiography in subjects aged > or = 90 years exists. The purpose of the present study was to elucidate the cardiac structure and function in the oldest old in order to assess the effect of aging on cardiac function. Echocardiographic examination was performed in 1793 subjects who were in their fifties, sixties, seventies, eighties, and nineties. Left ventricular (LV) wall thickness and dimension were measured by M-mode echocardiography. LV ejection fraction (LVEF) was calculated and used as the parameter representing LV systolic function. LV diastolic function was assessed using the peak velocity of early rapid filling (E velocity) and the peak velocity of atrial contraction (A velocity), and the ratio of E to A (E/A) by the transmitral flow. The Tei index, which reflects both LV diastolic and systolic function, was also calculated. The E/A decreased progressively with aging, and demonstrated the closest correlation with age among all the indexes of cardiac function (r = -0.44, P < 0.001). In contrast, LVEF and the Tei index demonstrated a very weak correlation with age (r = -0.13, P < 0.001 and r = 0.16, P < 0.001, respectively). The mean value for LVEF remained normal with aging in all age strata (50s: 71 +/- 8%, 60s: 71 +/- 8%, 70s: 70 +/- 9%, and 80s: 71 +/- 10%), but decreased significantly in subjects in their 90s (66 +/- 10%, P < 0.001). In addition, the mean value for the Tei index also remained normal with aging in subjects in their 50s (0.35 +/- 0.10), 60s (0.38 +/- 0.14), 70s (0.38 +/- 0.12), and 80s (0.39 +/- 0.15), but showed an abnormal value in subjects in their 90s (0.45 +/- 0.12, P < 0.001). In conclusion, both diastolic dysfunction and systolic dysfunction with advancing age were observed in the oldest old aged > or = 90 years. The age-related impairment of systolic function as well as diastolic function should be considered when echocardiography is used to evaluate the causes of heart failure in the oldest old.     

Cardiac structure and function in persons 85 years of age

Individuals aged >85 years constitute the world's most rapidly growing age group. Despite the rapid growth of this population and its high incidence of cardiovascular morbidity, normative data concerning cardiac structure and function are limited. The objective of this study was to define cardiac structure and function in an age-homogenous, community-dwelling population of subjects born in 1920 and 1921. Subjects were recruited from the Jerusalem Longitudinal Cohort Study. Echocardiography was performed using a portable echocardiograph at the subject's place of residence. Standard echocardiographic assessment of cardiac structure and function was performed. Four hundred fifty subjects (219 men, 231 women) were enrolled in the study. The cohort exhibited large left atrial volumes (64.6 ± 26 ml) and high left ventricular (LV) mass indexes (122 ± 36 g/m(2)) with normal LV volumes. Ejection fractions were preserved (55.3 ± 10.2%), but tissue Doppler s-wave velocities (lateral 7.8 ± 2.1 cm/s, septal 6.7 ± 1.9 cm/s) were reduced. Reduced tissue Doppler e waves (lateral 7.3 ± 2.2 cm/s, septal 6.2 ± 2 cm/s) and elevated E/e' ratios (12.2 ± 4.9) indicated significantly impaired diastolic function. In conclusion, the findings of this study demonstrate a high prevalence of left atrial enlargement, elevated LV mass, evidence of LV systolic dysfunction with preserved ejection fractions, and significant LV diastolic dysfunction in a community-dwelling cohort of 85-year-olds. The finding of elevated E/e' ratios in a subset free of known cardiovascular disease should be considered when clinical assessment of LV diastolic dysfunction in this age group is performed.     

Cardiac structure and function as predictors of mortality in persons 85 years of age

Individuals aged > 85 years are the world's most rapidly growing age group and have a high incidence of cardiovascular mortality. The objective of this study was to prospectively determine the prognosis of abnormal cardiac structure and function in an age-homogenous, community-dwelling population of subjects born in 1920 and 1921. Subjects were recruited from the Jerusalem Longitudinal Cohort Study. Echocardiography was performed with a portable echocardiograph at the subjects' places of residence. Standard echocardiographic assessment of cardiac structure and function was performed. Five-year mortality was assessed through a centralized government database. Five hundred two subjects (235 men, 267 women) were enrolled in the study, of whom 107 (21%) had died at the time of 5-year follow-up. Subjects who died had significantly higher left atrial volume indexes (42.3 ± 16.5 vs 36.6 ± 12.5 ml/m2, p < 0.01) and left ventricular mass indexes (133.1 ± 47.6 vs 119.8 ± 30.6 g/m2, p < 0.05). Ejection fractions were significantly lower in subjects who died (52.5 ± 11.5% vs 56.4 ± 9.4%, p < 0.003), but indexes of left ventricular diastolic function were not significantly different between the 2 groups (E/e' ratio 13.0 ± 5.3 vs 12.2 ± 4.9, p = 0.18). In conclusion, elevated left atrial volume index and left ventricular mass index and decreased LV systolic function predicted 5-year mortality in a community-dwelling population of subjects aged 85 years, even after correction for possible confounders. Left ventricular diastolic dysfunction did not predict 5-year mortality in this cohort.     

Changes in echocardiographic measures of systolic and diastolic function in children 1 year after hematopoietic SCT

Hematopoietic SCT (HSCT) is a life-saving therapy in children, but has been associated with heart failure. Little is known about subclinical changes in cardiac function. We examined changes in systolic and diastolic function from pre- to 1-year post HSCT by echocardiography. All patients (n=74, 61% men, median age 9.1 years, mean left-ventricular (LV) ejection fraction 61.3±4.9%) who underwent HSCT at Children's Hospital Boston between 2005 and 2008, were <21 years at time of HSCT, and had routine pre- and 1-year post echocardiograms were included. Systolic function parameters, including LV ejection fraction, rate-corrected velocity of fiber shortening (Vcfc) and stress-velocity index and diastolic parameters, including tissue Doppler imaging (TDI)-derived velocities, and left-ventricular flow propagation, were compared before and after transplant. At 1-year post HSCT, systolic function, as measured by Vcfc (1.10±0.15 vs 1.04±0.12?circ/s; P=0.03) and stress-velocity index (z-score 0.40±1.4 vs -0.20±1.1; P=0.02), had worsened; diastolic function parameters, including mitral E' velocity (16.6±3.9 vs 15.0±3.4?cm/s; P=0.01) and tricuspid E' velocity (14.3±3.6 vs 12.4±2.8?cm/s; P=0.002) had also decreased. At 1-year post HSCT, children have subclinical declines in systolic and diastolic function. These small changes might become clinically important over time. Serial non-invasive assessment of cardiac function should be considered in all children following HSCT.     

QRS记分与陈旧性心肌梗死左室功能的关系

为评价常规心电图ＱＲＳ记分与陈旧性心肌梗死者左室功能的关系，我们对５２例陈旧性心肌梗死者的ＱＲＳ记分与平衡法核素血池测得的ＬＶＥＦ，ＰＥＲ，ＰＥＲ，１／３ＥＦ，１／３ＦＲ，１／３ＥＲ，１／３ＥＦ进行相关分析，发现ＱＲＳ记分不仅与反映收缩功能的ＬＶＥＦ，ＰＥＲ，１／３ＥＦ，１／３ＥＲ明显负相关，而且与反映舒张功能的ＰＥＲ，１／３ＦＲ，１／３ＥＦ明显负相关，结果提示ＱＲＳ记分可用于估测陈旧性心肌梗死的     

应用心脏电影磁共振成像评估无明显心血管症状的2型糖尿病患者左心室功能

目的 利用心脏电影磁共振成像(MRI)评估无明显心血管症状的2型糖尿病患者左心室结构及功能变化.方法 入选2005年11月至2006年1月至天津医科大学总医院糖尿病门诊就诊的2型糖尿病患者85例(2型糖尿病组)及同期健康体检者43名(正常对照组),采用单因素两样本组内随机设计方法进行研究.行左心室短轴位电影MRI,计算并比较左心室整体功能指标(包括舒张末期容积指数、收缩末期容积指数、每搏输出量指数、心脏指数、射血分数、舒张末期质量指数和收缩末期质量指数)、局部功能(舒张末期厚度、收缩末期厚度、室壁增厚率和室壁运动)和血液动力学指标(高峰射血率、高峰射血时间、高峰充盈率和高峰充盈时间).计量资料行独立样本成组t检验,性别构成采用x2检验.采用Logistic逐步回归分析评估性别、年龄、身高、体重、体重指数、病程和空腹血糖对左心室功能影响的显著性.结果 2型糖尿病组收缩末期容积指数低于正常对照组[分别为(22±8)、(25±5)ml/m2,t=2.265,P＜0.05],射血分数高于正常对照组(分别为59%±9%、56%±6%,t=-2.457,P＜0.05),室壁增厚,高峰充盈率低于正常对照组[分别为(282±73)、(321±99)ml/s,t=2.508,P＜0.05].Logistic逐步回归分析显示,空腹血糖对左心室功能受损的影响近乎有统计学意义(x2=3.781,P=0.052).结论 心脏电影MRI是左心室功能测量的"金标准",能可靠评价无明显心血管症状的2型糖尿病患者左心室功能改变.无明显心血管症状的2型糖尿病患者舒张功能障碍早于收缩功能障碍,控制空腹血糖水平对避免发生左心室功能受损可能具有意义.     

QRS记分法评价老年心肌梗塞患者的左室功能

为评估常规心电图ＱＲＳ记分法评价老年心肌梗塞患者的左室收缩及舒张功能的价值，将常规心电图测得的老年急性心肌梗塞（ｎ＝６７）及陈旧性心肌梗塞（ｎ＝３２）的ＱＲＳ记分与９９ｍＴｃＭＩＢＩＳＰＥＣＴ心肌显像检测的心肌坏死、心肌疤痕节段数及平衡法核素心血池显像测得的左室射血分数（ＬＶＥＦ）、高峰射血率（ＰＥＲ）、１／３射血分数（１／３ＥＦ）、１／３充盈率（１／３ＦＲ）、高峰充盈率（ＰＦＲ）、１／３射血率（１／３ＥＲ）、１／３充盈分数（１／３ＦＦ）进行相关分析。发现ＱＲＳ记分与急性心肌梗塞者心肌坏死节段数及陈旧性心肌梗塞者的心肌疤痕节段数显著相关，ｒ分别为０．７８，０．６６，Ｐ均＜０．０００１；与反映收缩功能的ＬＶＥＦ、ＰＥＲ、１／３ＥＦ、１／３ＥＲ呈明显负相关，ｒ分别为－０．７３和－０．８６，－０．５５和－０．７３，－０．３６和－０．５５，－０．６５和－０．７７，Ｐ均＜０．０５；与反映舒张功能的ＰＦＲ、１／３ＦＲ、１／３ＦＦ亦呈明显相关，ｒ分别为－０．４５和０．４１，－０．４９和－０．５２，－０．３８和－０．３６，Ｐ均＜０．０５。说明ＱＲＳ记分可用于估测心肌梗塞面积、左室收缩及舒张功能。     

Diagnosis of diastolic heart failure

Nearly half of patients with heart failure (HF) have a normal ejection fraction (EF) and have been labeled as having diastolic HF. Diastolic HF is characterized by a normal EF, a variable amount of concentric left ventricular hypertrophy, and abnormal diastolic function. Differentiating diastolic HF from HF with a reduced EF (systolic HF) is important because these two forms of HF have different pathophysiology and thus might require different therapeutic approaches. Nevertheless, patients with diastolic HF and those with systolic HF have similar clinical symptoms and signs. Thus, clinical history and physical examination do not differentiate between diastolic and systolic HF. There is accumulating evidence that diastolic dysfunction is related to the severity of HF and prognosis regardless of EF. Thus, it is important to evaluate both systolic and diastolic function not only to differentiate between diastolic and systolic HF but also to identify high-risk patients.     

Evaluation of left ventricular diastolic function using an ambulatory radionuclide monitor: relationship to left ventricular systolic performance

Abnormalities of left ventricular (LV) filling may occur prior to systolic dysfunction in patients with both coronary and noncoronary heart disease. To determine the incidence of diastolic dysfunction and to assess the relationship of such dysfunction to systolic performance, we measured systolic and diastolic function at rest in a series of healthy volunteers (n = 10) and in patients with cardiovascular disease (n = 42). Twenty patients had coronary artery disease (CAD) with prior myocardial infarction, six patients had CAD without myocardial infarction, and the remaining 16 patients had a variety of noncoronary heart diseases, including valvular heart disease, dilated cardiomyopathy, and hypertensive disease. The 42 patients manifested a wide variation in LV systolic function (ejection fractions ranged from 6% to 65%). Patients with reduced LV ejection fraction (EF) manifested a reduction in cardiac output and peak ejection rate proportionate to the reduction in EF. Diastolic function showed a fall in LV peak (PFR) and average (AFR) filling rates; these were reduced in proportion to the fall in EF. Heart rate was an insensitive index of the magnitude of impairment of LV systolic function. These data suggest that measurements of diastolic function do not provide additional information in patients with impaired systolic function.     

Prognostic value of plasma brain natriuretic peptide, urea nitrogen, and creatinine in outpatients >70 years of age with heart failure

This study analyzed the relevance of plasma brain natriuretic peptide (BNP) and echocardiography in predicting cardiovascular events in a large population >70 years old with heart failure (HF). Three hundred four outpatients with HF (51.6% men, mean age 78.6) underwent transthoracic echocardiography and plasma BNP testing shortly before hospital discharge. Echocardiography was intended to reveal systolic dysfunction (left ventricular [LV] ejection fraction [EF] <50%) or diastolic dysfunction (EF > or =50% and abnormalities of ventricular relaxation). During 6-month follow-up, all-cause death and readmission were assessed. One hundred seventeen patients had diastolic dysfunction with preserved systolic LV function, and 187 had systolic dysfunction. At 6-month clinical follow-up, 33 subjects (10.9%) had died, and 62 (20.4%) needed readmission for cardiac decompensation. In all patients, univariate logistic regression demonstrated significant correlations between age (r = 0.14, p = 0.01), plasma BNP (r = 0.36, p = 0.0001), the EF (r = 0.16, p = 0.003), urea nitrogen (r = 0.35, p = 0.0001), serum creatinine (r = 0.27, p = 0.0001), and New York Heart Association (NYHA) class (r = 0.35, p = 0.0001) and the occurrence of cardiovascular events. In patients with HF in NYHA class III or IV, a BNP cut-off level of 200 pg/ml identified different outcomes (BNP <200 pg/ml in 1 of 20 events vs BNP >200 pg/ml in 55 of 85 events, p = 0.0001). In patients with HF who were >70 years old, BNP, NYHA class, and renal function predicted adverse outcome. In patients with severe HF, BNP was better than NYHA class in predicting future events.     

Early electrocardiographic evaluation of atrial fibrillation risk in beta-thalassemia major patients

Although previous studies have documented a variety of electrocardiogram abnormalities in beta-thalassemia major (β-TM), little is known about P-wave dispersion (PD), an independent risk factor for development of atrial fibrillation. The aim of our study was to evaluate PD in β-TM patients with conserved systolic and diastolic functions. The study involved 40 β-TM patients (age 37.5?±?10.2; 33?M) and 40 healthy subjects used as controls, matched for age and gender. PD was carefully measured using a 12-lead electrocardiogram. Cardiac iron levels were measured by cardiac magnetic resonance T2 star (CMR T2*) imaging. Comparing to the healthy control group, β-TM group presented increased values of the PD (40.1?±?12.9 vs. 24?±?7?ms; P?相似文献   

舒张压达到3级的青年高血压患者心脏结构和功能改变

目的 探究青年高血压患者中,单纯舒张压达到3级的高血压（DBP）和合并收缩压达到3级的高血压（DBP+SBP）两种类型的高血压对心脏结构和功能的影响情况。 方法 收集健康对照组（CON）93例、DBP组86例、DBP+SBP组101例,利用超声心动图检测各组的心脏结构、功能,计算左心室质量分数（LVMI）和相对室壁厚度（RWT）,比较三组人群心脏结构和功能的差异。 结果 DBP组、DBP+SBP组患者体质量指数（BMI）、吸烟史、家族史均比CON组高（均P<0.05）,而2组间均无明显差异。DBP组的收缩压、舒张压、平均动脉压均高于CON组（均P<0.01）。而DBP+SBP组的收缩压、平均动脉压均高于DBP组（均P<0.01）。但DBP组与DBP+SBP组中的舒张压未见明显差异。3组中代表心脏结构的左室短轴横径、左室短轴前后径、右室前后径、右室横径、左房横径、右房横径均无明显差异。但与CON组相比,DBP组与DBP+SBP组的左房前后径均增加（均P<0.05）,而后两者组间无明显差异。代表心脏外大血管结构主动脉内径、肺动脉内径也无明显差异。三组中的射血分数（EF）、短轴缩短率（FS）均无明显差异。与CON组相比,DBP 组和DBP+SBP组的E/A值均降低（均P<0.05）。但后2组组间无明显差异。 结论 舒张压达到3级的青年高血压患者,可出现左心室肥厚、左心房前后径增加等结构改变,同时左心室的舒张能力显著下降。而是否合并收缩压升高对上述改变无明显影响。     

Contribution of right-sided heart enlargement to cardiomegaly on chest roentgenogram in diastolic and systolic heart failure

We investigated the contribution of a dilated right-sided heart to roentgenographic cardiomegaly in patients with heart failure (HF) and a normal ejection fraction (EF; diastolic HF) and those with HF and a decreased EF (systolic HF). We compared the cardiothoracic ratio (CTR) on upright chest roentgenograms and major- and minor-axis dimensions of the 4 cardiac chambers on echocardiograms in patients with HF and a normal EF (> or =0.50, n = 35) and those with a decreased EF (<0.50, n = 37) and examined the correlation between the CTR and cardiac chamber dimensions. The CTR did not differ between patients with normal and decreased EF values (0.58 +/- 0.07 vs 0.60 +/- 0.06, p = 0.26). Left-side cardiac chamber dimensions were substantially smaller in patients with a normal EF than in those with a decreased EF (left ventricular minor-axis dimension, 4.4 +/- 0.7 vs 5.8 +/- 0.8 cm, p <0.001). In contrast, right-side cardiac chamber dimensions were generally similar between groups. The CTR correlated with major-axis dimensions of the right ventricle and right atrium (p <0.01 for the 2 comparisons), but not with the left-side cardiac chamber dimensions (all p values >0.05). In conclusion, the CTR predominantly reflects right- rather than left-sided heart size in patients with HF. Right-sided heart size is similar between patients with normal and decreased EF values. Thus, despite the substantial difference in left ventricular size and EF, there is substantial overlap in the CTR between patients with diastolic and systolic HFs and the CTR is unable to discriminate between groups.     

Enhanced left ventricular diastolic filling associated with long-term endurance training.

Normal aging is associated with an impairment in early left ventricular diastolic filling. To test the hypothesis that long-term endurance exercise training is associated with enhanced ventricular diastolic filling indices, we compared transmitral pulsed Doppler inflow spectra in healthy young adults; healthy elderly, sedentary subjects (sedentary old); and healthy elderly, endurance athletes (master athletes). Our data demonstrate that, despite an increase in left ventricular mass, early diastolic filling was enhanced in master athletes compared to the sedentary old. Blood pressure of both master athletes and the sedentary olds was greater than the young adults, but the higher blood pressure did not correlate to changes in filling parameters. Resting systolic function and heart rate were not significantly different in all three different groups. Early left ventricular filling indices in master athletes more closely resemble transmitral inflow patterns of healthy young adults. Long-term endurance exercise is associated with physiologic hypertrophy and ventricular filling dynamics more characteristic of the young than the old.     

Impaired left ventricular function in chronic aortic valve disease: survival and function after replacement by Bj?rk-Shiley prosthesis.

Postoperative survival and left ventricular function were studied in 128 patients who underwent isolated aortic valve replacement by the Bj?rk-Shiley valve between 1973 and 1977. The average follow-up was 2.1 years. Patients with associated coronary artery disease or mitral valve disease were excluded. Preoperative ejection fraction ranged from 15-84%. Forty-two patients were restudied by cardiac catheterization 9.1 +/- 1.1 months (mean +/- SEM) after valve replacement. The hospital mortality was 11%. Preoperative type of valve lesion, functional class, cardiothoracic ratio, and ejection fraction (EF) had no significant effect on postoperative survival up to 4 years. After operation, left ventricular mass (LVMI) and peak systolic wall stress (PSWS) fell significantly, while EF and mean normalized systolic ejection rate (MNSER) increased in aortic stenosis and in aortic insufficiency. Neither in aortic stenosis nor in aortic insufficiency was there a significant relation between preoperative ejection fraction and postoperative LVMI, EF, MNSER and PSWS. We attributed this to a marked improvement of left ventricular function in patients with preoperative impaired ventricular function. Six patients with paravalvular leak to restudy has a significantly lower EF and MNSER, and a higher PSWS than patients without leak. Patients without leak had normal EF, MNSER and PSWS when compared with 10 normal persons, but LVMI remained moderately elevated. Postoperative transprosthetic gradient was 11.9 mm Hg (range 0-64 mm Hg). We conclude that impaired cardiac function is completely restored after aortic valve replacement by Bj?rk-Shiley valve, if valve function is good. Patients with impaired cardiac function preoperatively did not have a poorer prognosis after operation than patients with normal function.     

动态血压监测评估高血压病人左心功能

采用24小时动态血压监测(ABPM)监测80例轻～中度高血压病人,观察夜间血压升高以及血压负荷>40%对收缩和舒张功能的影响.结果表明:夜间血压升高病人与夜间血压不升高病人比较,E峰最大血流速度(PE)/A峰最大血流速度(PA)及射血分数(EF)均显著降低(P<0.05),左室舒张末期直径增大(P<0.05);24小时收缩期和舒张期负荷>40%与40%比较,左室舒张末期直径增大(P<0.05),PE/PA、EF值显著降低(P<0.05).证实ABPM对高血压病人左心功能评估有一定的意义.     

Myocardial systolic and diastolic performance derived by 2-dimensional speckle tracking echocardiography in heart failure with normal left ventricular ejection fraction

Background- The aim of this study was to investigate the myocardial systolic and diastolic performance of the left ventricle (LV) in patients with heart failure with normal LV ejection fraction (HFNEF) through novel LV myocardial indices, which assess the systolic and diastolic function of the whole myocardium of the LV. Methods and Results- LV myocardial systolic and diastolic performance were assessed as the average value of peak systolic strain and peak early-diastolic strain rate, respectively, in longitudinal, circumferential, and radial directions from all LV segments using 2-dimensional speckle-tracking echocardiography. We studied patients with HFNEF and a control group consisting of asymptomatic subjects with LV diastolic dysfunction of similar age, sex, and LV ejection fraction. A total of 322 patients were included (92 with HFNEF and 230 with asymptomatic LV diastolic dysfunction). Myocardial systolic and diastolic LV performance were significantly lower in HFNEF (20.13±6.02% and 1.14±0.27 s(-1)) than in patients with asymptomatic LV diastolic dysfunction (25.33±6.06% and 1.37±0.33 s(-1), respectively; all P<0.0001). In addition, patients with HFNEF with low systolic and diastolic LV myocardial performance had significantly higher LV filling pressures (17.1±6.6 and 17.6±6.3 versus 12.0±5.1 and 11.7±4.7, respectively; all P<0.001) and lower cardiac output (4.8±1.0 L/min and 4.9±1.1 L/min versus 5.7±1.2 L/min and 5.8±1.1 L/min, respectively; all P<0.001) than patients with normal LV myocardial performance. In relation to these findings, the symptomatic status (ie, New York Heart Association functional class) was significantly altered in those patients with low systolic and diastolic LV myocardial performance. Conclusions- In patients with HFNEF, both systolic and diastolic LV myocardial performance are impaired, which is associated with increased LV filling pressures, decreased cardiac output, and worse New York Heart Association functional class. Therefore, the measurement of these myocardial parameters could be of great importance in HFNEF because these echocardiographic indices assess the multidirectional function of the whole myocardium of the LV, thereby allowing detection of an alteration of the global function of the LV which is associated with a worse symptomatic status in these patients.     

Postoperative outcome in aortic stenosis with diastolic heart failure compared to one with depressed systolic function

BACKGROUND: In patients with aortic stenosis (AS), the clinical outcome worsens after the development of angina, syncope, and heart failure. This study was performed to elucidate whether the outcome with AS was also poor in patients with diastolic heart failure. METHODS AND RESULTS: Fifty-two patients who had undergone aortic valve replacement (AVR) for AS were retrospectively classified into 3 groups (G) on the basis of LV ejection fraction (EF) and pulmonary wedge pressure (PWP): G-1) normal LVEF, low PWP (EF > or = 45% and PWP < 16 mmHg; n = 35), G-2) normal LVEF, high PWP (EF > or = 45% and PWP > or = 16 mmHg; n = 8), and G-3) low LVEF (EF < 45%; n = 9). Among these 3 groups, we compared the outcome after AVR. None of the patients died after the operation in AS with preserved LVEF irrespective of the PWP, whereas there were 3 cardiac deaths in AS with low EF irrespective of the PWP. CONCLUSIONS: In patients with AS, diastolic heart failure developed in addition to systolic heart failure. The development of LV systolic dysfunction in AS was regarded as poor during the postoperative course, but diastolic heart failure did not affect the outcome. The occurrence of heart failure with preserved systolic function may have a slightly better prognosis and may still be suitable for AVR.     

Ⅲ度房室传导阻滞患者高位右室间隔部起搏VAT与DDD模式对左心功能的影响

目的通过研究Ⅲ度房室传导阻滞患者高位右室间隔部起搏(HRVS)时,VAT与DDD模式对心功能的影响,探讨心房的生理收缩和舒张对左心功能的作用。方法 32例Ⅲ度房室传导阻滞患者,在HRVS时,分别给予DDD模式或VAT模式工作,于调控即刻通过超声心动图测定二尖瓣口快速充盈期峰值血流速度(Ep),二尖瓣口左房收缩期峰值血流速度(Ap),二尖瓣环后壁处收缩期脉冲组织多普勒峰值速度平均值(Vs),二尖瓣环后壁处舒张早期脉冲组织多普勒峰值速度平均值(Ve),二尖瓣环后壁处舒张晚期脉冲组织多普勒峰值速度平均值(Va),二尖瓣血流频谱等容舒张时间(IVRT),通过Ep/Ap,Ve/Va,Ep/Ve和IVRT评价左室舒张功能,通过Vs,LVEF和LVFS评价收缩功能。结果 HRVS时DDD较VAT模式Ep/Ap、Ve/Va、Ep/Ve,IVRT差异有显著性(0.97±0.11 vs 1.01±0.11,0.89±0.09 vs 0.97±0.07,6.00±0.45 vs 6.24±0.36,100.4±14.32 vs 89.99±7.94;P均<0.01),Vs、左室射血分数和左室短轴缩短率无显著性差异。结论Ⅲ度房室传导阻滞时,HRVS起搏时,DDD模式较VAT模式使左室舒张功能下降,收缩功能无影响,表明了心房生理性起搏的重要性。