射血分数保留心力衰竭合并心房颤动心脏结构功能的特点

Echocardiographic features of heart failure with preserver ejection fraction with atrial fibrillation

目的:研究射血分数保留心力衰竭(HFpEF)合并心房颤动(AF)患者肺动脉压及右心结构功能改变的特点。方法:HFpEF患者共349例,其中221例无AF病史且心脏彩超检查时无AF发作(HFpEF+N-AF组)、45例有AF病史但检查时无AF发作(HFpEF+E-AF组)、83例有AF病史且检查时有AF发作(HFpEF+C-AF组)。观察3组肺动脉压及右心结构改变的特点,另以同期102例健康人群为参考,得出3组右心结构指标的异常率。结果:HFpEF+C-AF组的RV-D1、RV-D2、RVOT2、RA-D1、RA-D2、RAA、LAD、LADi、LAV、LAVi大于HFpEF+E-AF组和HFpEF+N-AF组(P<0.05);与HFpEF+N-AF组比较,HFpEF+C-AF组FS、EF、DT、IVRT、E/E′_L、E/E′s、E/E′、FPV减低,E、E′_L、E′s增加(P<0.01);与HFpEF+E-AF组比较,HFpEF+C-AF组FS减低,E、E′_L、E′s、FPV增加(P<0.01)。多元逐步回归分析显示,3组RV-D2、RV-D3与LVEDVi独立相关,HFpEF+C-AF组和HFpEF+N-AF组RV-D1、RV-D2、RA-D2与LAVi独立相关,HFpEF+N-AF组RV-D1、RV-D2、RA-D1、RA-D2、RAA与PASP独立相关。结论:在HFpEF患者中,AF患者右心结构异常更显著,并且这种异常以右心房为主。AF患者存在明显的右心结构改变,但其舒张功能减退并不明显。相关性分析显示AF与右心结构改变之间的关系与肺动脉压无关,可能与HFpEF进展的原因、AF的减压机制有关。

Objective: To investigate the changes of pulmonary artery pressure and right heart structure and function in patients with HFpEF with atrial fibrillation(AF). Methods: A total of 349 HFpEF patients were enrolled, including 221 patients who had no history of AF and had no AF at the time of echocardiography(HFpEF+N-AF group), 45 patients who had a history of AF but had no AF at the time of echocardiography(HFpEF+E-AF group), and 83 patients who had a history of AF and had AF at the time of echocardiography(HFpEF+C-AF group). The characteristics of pulmonary artery pressure and right heart structure of the three groups were observed, separately. In addition, taking 102 healthy people as references, the abnormal rates of right heart structure index of the three groups were obtained, separately. Results: RV-D1, RV-D2, RVOT2, RA-D1, RA-D2, RAA, LAD, LADi, LAV, and LAVi of HFpEF+C-AF group were higher than those of HFpEF+E-AF group and HFpEF+N-AF group(P<0.05). Compared with HFpEF+N-AF group, FS, EF, DT, IVRT, E/E′L, E/E′s, E/E′, and FPV in HFpEF+C-AF group were decreased, while E, E′L and E′s were increased(P<0.01);Compared with HFpEF+E-AF group, FS in HFpEF+C-AF group were decreased, while E, E′L, E′s, FPV were increased(P<0.01). Multiple stepwise regression analysis showed that RV-D2 and RV-D3 were independently correlated with LVEDVi in the three groups;in HFpEF+C-AF group and HFpEF+N-AF group, RV-D1, RV-D2, and RA-D2 were independently correlated with LAVi;in HFpEF+N-AF group, RV-D1, RV-D2, RA-D1, RA-D2, and RAA were independently correlated with PASP. Conclusion: Among patients with HFpEF, the abnormality of right heart structural in AF patients is more significant, and this abnormality is mainly in the right atrium. The right heart structural changes in patients with AF is significant, while the diastolic function was not significantly decreased. Correlation analysis showed that the relationship between AF and right heart structural changes was not related to pulmonary artery pressure. It might be related to the cause of the progression of HFpEF and the decompression mechanism of AF.