左室射血分数正常的心力衰竭患者的临床特点及左室收缩功能

目的 应用超声测量左室射血分数(LVEF)正常的心力衰竭(心衰)患者的房室平面位移,观察该类患者是否存在心室长轴方向收缩功能异常.方法 收集住院心衰患者96例,LVEF正常心衰组和LVEF降低心衰组各48例,50例健康体检者入选为对照组.比较各组在NYHA心功能分级、基础病因、房室平面位移、血浆N末端B型利钠肽原浓度的差异.结果 LVEF正常心衰组和LVEF降低心衰组的NYHA心功能分级差异无统计学意义.LVEF正常心衰组常见病因为高血压性心脏病和冠心病.对照组、LVEF正常心衰组、LVEF降低心衰组的房室平面位移依次下降.房室平面位移与血浆N末端B型利钠肽原水平负相关(r=-0.35,P<0.05).结论 通过传统方法测定的LVEF正常心衰组患者存在心室长轴方向上的收缩功能异常,而非单纯的舒张性心衰.

Reduced left ventricular systolic atrioventricular plane displacement in heart failure patients with preserved ejection fraction

Objective To determine whether patients with suspected heart failure but preserved left ventricular ejection fraction (LVEF) have systolic dysfunction in left ventricular long axis detected by left ventricular systohc atrioventricular plane displacement (AVPD). Methods The data of 96 patients with heart failure who admitted to our hospital between August 2007 and October 2008 were collected. Heart failure with preserved LVEF was diagnosed in 48 patients and heart failure with reduced LVEF was diagnosed in another 48 patients. Fifty age-matched healthy subjects served as the control group. The NYHA classification, etiology of heart failure, AVPD and plasma NT-proBNP concentration were compared among the 3 groups. Results There was no difference in terms of NYHA classification between patients with preserved LVEF and reduced LVEF. Hypertension and coronary heart disease were often diagnosed in heart failure patients with preserved LVEE The degree of AVPD decrease was more significant in heart failure patients with reduced LVEF than those with preserved LVEE. In all subjects, the AVPD was negatively correlated with the NT-proBNP concentration (r=-0.35, P<0.05) . Conclusion Left ventricular systolic atrioventricular plane displacement was decreased in heart failure patients with preserved LVEF, therefore, besides "diastolic heart failure", systolic dysfunction was also impaired in these patients.