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

被引:99
作者
Brucks, S [1 ]
Little, WC [1 ]
Chao, T [1 ]
Kitzman, DW [1 ]
Wesley-Farrington, D [1 ]
Gandhi, S [1 ]
Shihabi, ZK [1 ]
机构
[1] Wake Forest Univ, Sch Med, Cardiol Sect, Winston Salem, NC 27157 USA
关键词
D O I
10.1016/j.amjcard.2004.11.006
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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 less than or equal to0.40 (4.8 +/- 1.1 cm/s) and, to a lesser extent, an ejection fraction greater than or equal to0.50 (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 greater than or equal to0.50 had an increased ratio of ventricular mass to EDVI. Patients who had HF and an ejection fraction :less than or equal to0.40 had increased left ventricular EDVI. Thus, regardless of ejection fraction, patients who have HF also have diastolic dysfunction. Diastolic dysfunction is a better predictor of B-type natriuretic peptide levels and mortality than ejection fraction or left ventricular EDVI. In addition to diastolic dysfunction, HF with an ejection fraction greater than or equal to0.50 is associated with mild systolic dysfunction and an increased ratio of left ventricular mass to EDVI. In HF with an ejection fraction less than or equal to0.40, systolic dysfunction and left ventricular dilation accompany diostolic dysfunction. (C)2005 by Excerpta Medica Inc.
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页码:603 / 606
页数:4
相关论文
共 19 条
  • [1] Appleton Christopher P., 2000, Cardiology Clinics, V18, P513, DOI 10.1016/S0733-8651(05)70159-4
  • [2] A multivariate model for predicting mortality in patients with heart failure and systolic dysfunction
    Brophy, JM
    Dagenais, GR
    McSherry, F
    Williford, W
    Yusuf, S
    [J]. AMERICAN JOURNAL OF MEDICINE, 2004, 116 (05) : 300 - 304
  • [3] Relation of anemia to diastolic heart failure and the effect on outcome
    Brucks, S
    Little, WC
    Chao, T
    Rideman, RL
    Upadhya, B
    Wesley-Farrington, D
    Sane, DC
    [J]. AMERICAN JOURNAL OF CARDIOLOGY, 2004, 93 (08) : 1055 - 1057
  • [4] The pathogenesis of acute pulmonary edema associated with hypertension.
    Gandhi, SK
    Powers, JC
    Nomeir, A
    Fowle, K
    Kitzman, DW
    Rankin, KM
    Little, WC
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 2001, 344 (01) : 17 - 22
  • [5] New Doppler echocardiographic applications for the study of diastolic function
    Garcia, MJ
    Thomas, JD
    Klein, AL
    [J]. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1998, 32 (04) : 865 - 875
  • [6] N-terminal pro-brain natriuretic peptide -: A new gold standard in predicting mortality in patients with advanced heart failure
    Gardner, RS
    Özalp, F
    Murday, AJ
    Robb, SD
    McDonagh, TA
    [J]. EUROPEAN HEART JOURNAL, 2003, 24 (19) : 1735 - 1743
  • [7] Diastolic mitral annular velocity during the development of heart failure
    Hasegawa, H
    Little, WC
    Ohno, M
    Brucks, S
    Morimoto, A
    Cheng, HJ
    Cheng, CP
    [J]. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2003, 41 (09) : 1590 - 1597
  • [8] Pathophysiological characterization of isolated diastolic heart failure in comparison to systolic heart failure
    Kitzman, DW
    Little, WC
    Brubaker, PH
    Anderson, RT
    Hundley, WG
    Marburger, CT
    Brosnihan, B
    Morgan, TM
    Stewart, KP
    [J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2002, 288 (17): : 2144 - 2150
  • [9] Importance of heart failure with preserved systolic function in patients ≥65 years at age
    Kitzman, DW
    Gardin, JM
    Gottdiener, JS
    Arnold, A
    Boineau, R
    Aurigemma, G
    Marino, EK
    Lyles, M
    Cushman, M
    Enright, PL
    [J]. AMERICAN JOURNAL OF CARDIOLOGY, 2001, 87 (04) : 413 - 419
  • [10] Utility of B-natriuretic peptide in detecting diastolic dysfunction - Comparison with Doppler velocity recordings
    Lubien, E
    DeMaria, A
    Krishnaswamy, P
    Clopton, P
    Koon, J
    Kazanegra, R
    Gardetto, N
    Wanner, E
    Maisel, AS
    [J]. CIRCULATION, 2002, 105 (05) : 595 - 601