Yi Wang, Quirino Ciampi, Lauro Cortigiani, Angela Zagatina, Ratnasari Padang, Garvan C Kane, Hector R Villarraga, Jesus Peteiro Vazquez, Elena Kalinina, Alla Boshchenko, Tamara Ryabova, Fiore Manganelli, Hugo Rodriguez-Zanella, Jelena Celutkiene, Elisa Merli, Clarissa Borguezan-Daros, Jorge Lowenstein, Rosina Arbucci, Diego M Lowenstein Haber, Sofia Marconi, Pablo M Merlo, Karina Wierzbowska-Drabik, Ayten Safarova, Tatiana Timofeeva, Ariel Saad, Francesca Bursi, Jaroslaw D Kasprzak, Ana Djordjevic-Dikic, Sergio Kobal, Dimitrios Soulis, Nicola Gaibazzi, Nithima Chaowalit Ratanasit, Rodolfo Citro, Albert Varga, Marco Fabio Costantino, Fausto Rigo, Aleksandra Nikolic, Giovanni Benfari, Miguel Amor, Ana Cristina Camarozano, Rosangela Cocchia, Attila Palinkas, Antonello D'Andrea, Miodrag Ostojic, Tamara Kovačević Preradović, Iana Simova, Federica Re, Paolo Colonna, Maria Grazia D'Alfonso, Fabio Mori, Claudio Dodi, Filipa Xavier Valente, Giovanni Tripepi, Lixue Yin, Mauro Pepi, Scipione Carerj, Patricia A Pellikka, Eugenio Picano
{"title":"静息容积经胸超声心动图左心室弹性识别保留射血分数的心力衰竭的不同表型：一项多中心前瞻性观察研究的回顾性分析。","authors":"Yi Wang, Quirino Ciampi, Lauro Cortigiani, Angela Zagatina, Ratnasari Padang, Garvan C Kane, Hector R Villarraga, Jesus Peteiro Vazquez, Elena Kalinina, Alla Boshchenko, Tamara Ryabova, Fiore Manganelli, Hugo Rodriguez-Zanella, Jelena Celutkiene, Elisa Merli, Clarissa Borguezan-Daros, Jorge Lowenstein, Rosina Arbucci, Diego M Lowenstein Haber, Sofia Marconi, Pablo M Merlo, Karina Wierzbowska-Drabik, Ayten Safarova, Tatiana Timofeeva, Ariel Saad, Francesca Bursi, Jaroslaw D Kasprzak, Ana Djordjevic-Dikic, Sergio Kobal, Dimitrios Soulis, Nicola Gaibazzi, Nithima Chaowalit Ratanasit, Rodolfo Citro, Albert Varga, Marco Fabio Costantino, Fausto Rigo, Aleksandra Nikolic, Giovanni Benfari, Miguel Amor, Ana Cristina Camarozano, Rosangela Cocchia, Attila Palinkas, Antonello D'Andrea, Miodrag Ostojic, Tamara Kovačević Preradović, Iana Simova, Federica Re, Paolo Colonna, Maria Grazia D'Alfonso, Fabio Mori, Claudio Dodi, Filipa Xavier Valente, Giovanni Tripepi, Lixue Yin, Mauro Pepi, Scipione Carerj, Patricia A Pellikka, Eugenio Picano","doi":"10.1016/j.echo.2024.12.012","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous entity including different phenotypes of near normal, normal, and supernormal left ventricular (LV) function. The aim of this study was to assess the value of resting LV elastance (also known as force) using transthoracic echocardiography to identify HFpEF phenotypes.</p><p><strong>Methods: </strong>In a prospective, observational, multicenter study, 2,380 patients with HFpEF were recruited from July 2016 to May 2024. Systolic blood pressure (SBP) was measured. LV end-diastolic volume (LVEDV), LV end-systolic volume (LVESV), LV ejection fraction, force (SBP/LVESV), stroke volume (SV), arterial elastance, ventricular-arterial coupling, and left atrial volume index were assessed. Global longitudinal strain was available in 1,164 patients (48.9%). Six hundred eighty patients finished follow-up with a composite endpoint of major adverse cardiac events (MACEs). Patients were divided into three groups: group 1, low force (<25th percentile, <3.24 mm Hg/mL); group 2, intermediate force (≥25th percentile and ≤75th percentile, 3.24-5.48 mm Hg/mL); and group 3, high force (>75th percentile, >5.48 mmHg/mL).</p><p><strong>Results: </strong>The three groups showed a gradient with descending values (group 3 > group 2 > group 1) for SBP, LV ejection fraction, global longitudinal strain, arterial elastance, and ventricular-arterial coupling, with the opposite gradient (group 1 > group 2 > group 3) for LVEDV, LVESV, SV, and left atrial volume index values (P < .01 for all). After a median follow-up period of 16 months, 205 MACEs occurred in 138 patients. The cumulative MACE rate was lowest in group 2 (14.7% person-years) and higher in groups 1 (16.1% person-years) and 3 (22.9% person-years; log-rank P = .036).</p><p><strong>Conclusions: </strong>Patients with HFpEF present with different LV contractile phenotypes, easily identified with resting LV force and volumetric transthoracic echocardiography. The dominant hemodynamic feature of hypocontractile phenotype is a preload recruitment with larger LVEDV and normal SV, while the hypercontractile phenotype is characterized by a small left ventricle with reduced SV. The hypercontractile and hypocontractile phenotypes are associated with a higher risk for subsequent events.</p>","PeriodicalId":50011,"journal":{"name":"Journal of the American Society of Echocardiography","volume":" ","pages":""},"PeriodicalIF":5.4000,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Left Ventricular Elastance With Resting Volumetric Transthoracic Echocardiography Identifies Different Phenotypes in Heart Failure With Preserved Ejection Fraction: A Retrospective Analysis of a Multicenter Prospective Observational Study.\",\"authors\":\"Yi Wang, Quirino Ciampi, Lauro Cortigiani, Angela Zagatina, Ratnasari Padang, Garvan C Kane, Hector R Villarraga, Jesus Peteiro Vazquez, Elena Kalinina, Alla Boshchenko, Tamara Ryabova, Fiore Manganelli, Hugo Rodriguez-Zanella, Jelena Celutkiene, Elisa Merli, Clarissa Borguezan-Daros, Jorge Lowenstein, Rosina Arbucci, Diego M Lowenstein Haber, Sofia Marconi, Pablo M Merlo, Karina Wierzbowska-Drabik, Ayten Safarova, Tatiana Timofeeva, Ariel Saad, Francesca Bursi, Jaroslaw D Kasprzak, Ana Djordjevic-Dikic, Sergio Kobal, Dimitrios Soulis, Nicola Gaibazzi, Nithima Chaowalit Ratanasit, Rodolfo Citro, Albert Varga, Marco Fabio Costantino, Fausto Rigo, Aleksandra Nikolic, Giovanni Benfari, Miguel Amor, Ana Cristina Camarozano, Rosangela Cocchia, Attila Palinkas, Antonello D'Andrea, Miodrag Ostojic, Tamara Kovačević Preradović, Iana Simova, Federica Re, Paolo Colonna, Maria Grazia D'Alfonso, Fabio Mori, Claudio Dodi, Filipa Xavier Valente, Giovanni Tripepi, Lixue Yin, Mauro Pepi, Scipione Carerj, Patricia A Pellikka, Eugenio Picano\",\"doi\":\"10.1016/j.echo.2024.12.012\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous entity including different phenotypes of near normal, normal, and supernormal left ventricular (LV) function. The aim of this study was to assess the value of resting LV elastance (also known as force) using transthoracic echocardiography to identify HFpEF phenotypes.</p><p><strong>Methods: </strong>In a prospective, observational, multicenter study, 2,380 patients with HFpEF were recruited from July 2016 to May 2024. Systolic blood pressure (SBP) was measured. LV end-diastolic volume (LVEDV), LV end-systolic volume (LVESV), LV ejection fraction, force (SBP/LVESV), stroke volume (SV), arterial elastance, ventricular-arterial coupling, and left atrial volume index were assessed. Global longitudinal strain was available in 1,164 patients (48.9%). Six hundred eighty patients finished follow-up with a composite endpoint of major adverse cardiac events (MACEs). Patients were divided into three groups: group 1, low force (<25th percentile, <3.24 mm Hg/mL); group 2, intermediate force (≥25th percentile and ≤75th percentile, 3.24-5.48 mm Hg/mL); and group 3, high force (>75th percentile, >5.48 mmHg/mL).</p><p><strong>Results: </strong>The three groups showed a gradient with descending values (group 3 > group 2 > group 1) for SBP, LV ejection fraction, global longitudinal strain, arterial elastance, and ventricular-arterial coupling, with the opposite gradient (group 1 > group 2 > group 3) for LVEDV, LVESV, SV, and left atrial volume index values (P < .01 for all). After a median follow-up period of 16 months, 205 MACEs occurred in 138 patients. The cumulative MACE rate was lowest in group 2 (14.7% person-years) and higher in groups 1 (16.1% person-years) and 3 (22.9% person-years; log-rank P = .036).</p><p><strong>Conclusions: </strong>Patients with HFpEF present with different LV contractile phenotypes, easily identified with resting LV force and volumetric transthoracic echocardiography. The dominant hemodynamic feature of hypocontractile phenotype is a preload recruitment with larger LVEDV and normal SV, while the hypercontractile phenotype is characterized by a small left ventricle with reduced SV. The hypercontractile and hypocontractile phenotypes are associated with a higher risk for subsequent events.</p>\",\"PeriodicalId\":50011,\"journal\":{\"name\":\"Journal of the American Society of Echocardiography\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":5.4000,\"publicationDate\":\"2025-01-14\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of the American Society of Echocardiography\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.echo.2024.12.012\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the American Society of Echocardiography","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.echo.2024.12.012","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Left Ventricular Elastance With Resting Volumetric Transthoracic Echocardiography Identifies Different Phenotypes in Heart Failure With Preserved Ejection Fraction: A Retrospective Analysis of a Multicenter Prospective Observational Study.
Background: Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous entity including different phenotypes of near normal, normal, and supernormal left ventricular (LV) function. The aim of this study was to assess the value of resting LV elastance (also known as force) using transthoracic echocardiography to identify HFpEF phenotypes.
Methods: In a prospective, observational, multicenter study, 2,380 patients with HFpEF were recruited from July 2016 to May 2024. Systolic blood pressure (SBP) was measured. LV end-diastolic volume (LVEDV), LV end-systolic volume (LVESV), LV ejection fraction, force (SBP/LVESV), stroke volume (SV), arterial elastance, ventricular-arterial coupling, and left atrial volume index were assessed. Global longitudinal strain was available in 1,164 patients (48.9%). Six hundred eighty patients finished follow-up with a composite endpoint of major adverse cardiac events (MACEs). Patients were divided into three groups: group 1, low force (<25th percentile, <3.24 mm Hg/mL); group 2, intermediate force (≥25th percentile and ≤75th percentile, 3.24-5.48 mm Hg/mL); and group 3, high force (>75th percentile, >5.48 mmHg/mL).
Results: The three groups showed a gradient with descending values (group 3 > group 2 > group 1) for SBP, LV ejection fraction, global longitudinal strain, arterial elastance, and ventricular-arterial coupling, with the opposite gradient (group 1 > group 2 > group 3) for LVEDV, LVESV, SV, and left atrial volume index values (P < .01 for all). After a median follow-up period of 16 months, 205 MACEs occurred in 138 patients. The cumulative MACE rate was lowest in group 2 (14.7% person-years) and higher in groups 1 (16.1% person-years) and 3 (22.9% person-years; log-rank P = .036).
Conclusions: Patients with HFpEF present with different LV contractile phenotypes, easily identified with resting LV force and volumetric transthoracic echocardiography. The dominant hemodynamic feature of hypocontractile phenotype is a preload recruitment with larger LVEDV and normal SV, while the hypercontractile phenotype is characterized by a small left ventricle with reduced SV. The hypercontractile and hypocontractile phenotypes are associated with a higher risk for subsequent events.
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The Journal of the American Society of Echocardiography(JASE) brings physicians and sonographers peer-reviewed original investigations and state-of-the-art review articles that cover conventional clinical applications of cardiovascular ultrasound, as well as newer techniques with emerging clinical applications. These include three-dimensional echocardiography, strain and strain rate methods for evaluating cardiac mechanics and interventional applications.
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