Aim. To study the heart structural and functional state in confirmed heart failure with preserved ejection fraction (HFpEF) depending on the severity of left ventricle (LV) diastolic dysfunction. Material and methods. Data from 303 patients with LV diastolic dysfunction (men 45,2%, mean age 66,3±6,0 years) were analyzed. The diastolic stress test (DST) was performed when the criteria for HFpEF according to resting echocardiography data was insufficient (n=251). The study included 153 patients with confirmed HFpEF (men 35,3%, mean age 67,0±5,6 years). Group I (n=101) included patients with decreased LV diastolic reserve in DST (E/e’ >14), while group II (n=52) — patients with significant LV diastolic dysfunction at rest who do not require DST to verify HFpEF. The speckle-tracking echocardiography was used to assess left atrial reservoir strain (LASr). Results. Significant differences were found in the 6-min walk test (400,0 360,0;440,0 m in group I vs 365,5 310,5;401,5 m in group II, respectively; p<0,001) and N-terminal pro-brain natriuretic peptide (NT-proBNP) level (257,7 100,0;443,3 pg/ml and 412,0 191,4;780,2 pg/ml; p=0,002). Resting echocardiography revealed significant differences in the left atrium (LA) volume index (VI) (33,5 29,2;40,1 ml/m 2 vs 40,8 37,3; 47,6 ml/m 2 ; p<0,001), E/e’ ratio (11,3 10,1;12,6 and 16,3 14,9;19,2; p<0,001), LASr (21,3 19,5;24,7% and 15,0 12,5;17,3%; p<0,001). Following moderate correlations were found in patients with HFpEF: LASr and E/e’ (r=-0,538; p<0,001), LASr and LAVI (r=-0,443; p<0,001). There was no correlation between LASr and NT-proBNP (r=-0,157; p=0,060). When analyzing the DST, significant differences were found in all characteristics in group I. Conclusion. Patients with confirmed HFpEF with an increase in LV filling pressure are characterized by LA reservoir dysfunction and LA dilation. Phase analysis of LA strain and DST allows for timely diagnosis of HFpEF.
Широков et al. (Fri,) studied this question.