| Object:Use two-dimension speckle tracking imaging and strain rate imaging to evaluate heart failure with preserved ejection fraction (HFpEF) patients’ left ventricular strain(S) and strain rate(SR) changes. And to explore the clinical value about strain and strain rate in diagnosis HFpEF patients. Methods:In this study.98 patients who hospitalized in the cardiology department the First Affiliated Hospital of Guangxi Medical University during April 2013 to December 2014 were enrolled. All patients were selected according to the consensus statement on the diagnosis of heart failure with preserved left ventricular ejection fraction by the Heart Failure and Echocardiography Association of the European Society of Cardiology(ESC) in 2007. While patients who with the folliwing disease were excluded:(1) with the left heart failure symptoms and (or) signs, but the blood NT-proBNP level <120pg/ml; (2) restrictive cardiomyopathy, hypertrophic obstructive cardiomyopathy, constrictive pericarditis, severe valvular heart disease; (3) have a history of myocardial infarction and the emergence of regional wall motion abnormalities in recentlly; (4) pulmonary heart disease and pulmonary hypertension; (5) severe liver, kidney dysfunction; (6) some endocrine and metabolic diseases, such as Graves’disease, Cushing’s syndrome; (7) congenital heart disease. According to NYHA grade standard, the 98 cases of HFpEF patients were divided into three subgroups, as NYHA grade Ⅱ group of 35 cases, NYHA grade Ⅲ group of 33 cases, NYHA grade IV group of 30 cases. The 41 cases of healthy volunteers were selected for the normal control group. The early peak of diastolic flow velocity (E) of mitral was measured by the Color Doppler Imaging, the early average peak of diastolic velocity (E’) of mitral was measured by the Tissue Doppler Imaging from the annular septal and the sidewall of the left ventricular, then the E/E’ratio was calculated. The early diastolic peak strain rate (ESR) and late diastolic peak strain rate (ASR) of the left ventricular were detected by Strain Rate Imaging. The globe left ventricular systolic longitudinal strain (GLS) was calculated by the Two-dimensional Speckle Tracking Imaging. The left ventricular ejection fraction (LVEF) was measured by Simposon method. And the blood potential application of N-terminal Pro-brain natriuretic peptide (NT-proBNP) levels were detected. Then each index was analyzed and compared among groups. Result:1. there was no significant difference between the NYHA grade Ⅱ group and the normal control group (P>0.05), but was statistically different among the rest group(P<0.05) for LVEF, NYHA grade Ⅲ group and NYHA grade IV group were lower than the normal control group, and decreased with the aggravation of the heart failure symptoms. The blood NT-proBNP levels and E/E’ ratio were higher than the normal control group, the differences were statistically significant (P<0.05), and increased gradually among the NYHA grade Ⅱ group, the NYHA grade Ⅲ group and NYHA grade Ⅳ group.2. ESR, ASR, GLS in the HFpEF patients were lower than the normal control group, the differences were statistically significant (P<0.05), and gradually reduced among the NYHA grade Ⅱ group, the NYHA grade Ⅲ group and NYHA grade Ⅳ group.3.The NYHA grade Ⅱ group, the NYHA grade Ⅲ group and the NYHA grade Ⅳ group HFpEF patients, the ESR was negative correlated to E/E’ ratio with satistical significance(r=-0.54,-0.55,-0.53), and blood NT-proBNP levels was negative correlated to ASR with satistical significance(r=-0.55,-0.57,-0.57), all P<0.05. Conclusion:Compared with the normal control group, LVEF was in the normal range while GLS decreasing, suggested that GLS was more sensitive than LVEF in discovering the changes of the systolic dysfunction for HFpEF patients. GLS was gradually decreased while the heart failure symptoms aggravated, it can be used to evaluating early systolic dysfunction of HFpEF patients.2. ESR and ASR can be used to evaluate the left ventricular diastolic function of HFpEF patients, and was gradually reduced while the heart failure NYHA grade increasing. For different NYHA grades, ESR, ASR were negative correlated to E/E’ ratio and blood NT-proBNP levels, indicated that ESR, ASR were new indicators to assessment the left ventricular diastolic function for HFpEF patients. |
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