| BackgroundHeart failure is the last battlefield of cardiovascular diseases,which can be described as "malignant tumor" of the heart.In the guidelines for the diagnosis and treatment of acute and chronic heart failure published in 2016 by ESC,there is an update for the classification of heart failure.Between the HErEF and HFpEF,there is a gray zone,containing a group of patients with the LVEF 40-49%.Now it is defined as HFmrEF,and has been given the clear diagnostic criteria.Regarding HFmrEF as a separate category will contribute to further researches for pathophysiology,clinical characteristics and therapies of this group.For the past few years,techniques about intra cardiac cavity flow visualization mainly concentrate upon echo-PIV,VFM and CMR.VFM technique combines color doppler imaging and speckle tracking techniques.Using continuity equation,velocity vector at any point in the region of interest can be obtained.In addition,it can quantitatively calculate blood flow energy loss caused by blood viscous friction.At present,there is no report on the energy loss of the left ventricle in patients with HFmrEF.In this study the two-dimensional echocardiography,color doppler flow imaging(CDFI),tissue doppler imaging(TDI),2D Tissue Tracking(2DTT)and VFM technology are applied to make a comprehensive evaluation of cardiac structure and function change,and the characteristics of the EL in left ventricle in the patients with HFmrEF.Objectives1.To evaluate the characteristics of EL in left ventricle by VFM in patients with HFmrEF.2.Explore the relationship between EL and cardiac structure and function in patients with HFmrEF.Materials and Methods1.patients and grouping Forty-three inpatients with present LVEF between 40-49%were collected continuously in Qilu Hospital of Shandong University.Among them,28 patients were selected according to diagnostic criteria of HFmrEF in the 2016 ESC guidelines.At the same time,we collected 23 healthy volunteers matched in age and gender.According to "Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography" published in 2016,28 HFmrEF patients were divided into 2 groups:Diastolic dysfunction group(group I,n=12),non-diastolic dysfunction group(group II,n=16).2.clinical dataTake notes of gender,age,height,weight,heart rate,blood pressure of all the patients and healthy volunteers.Collect medical history and level of NT-proBNP,fasting blood glucose and blood lipids in HFmrEF patients.3.echocardiographic data acquisitionAloka Prosound F75 color doppler diasonograph is used in image acquisition.Two-dimensional echocardiography:IVS,LVEDd,LVPW,LVM,LVMI,LA,EDV,ESV,LVEF,CO,LAV,LAVI,L,S,SI.Color doppler flow imaging:E,A,E/A.Tissue doppler imaging:e',E/e'.2DTT:GLS.VFM:EL in left ventricle in IVR,RFP,ACP,IVC,REP.Statistical analysisSPSS20.0 software was applied for statistical analysis and drawing.All the measurement data were expressed as meaną standard deviation.Independent sample T test was used to compare the two groups.Categorical variables were tested by X2.Pearson correlation analysis was used to analyze the correlation of continuous variables.The effects of the explanatory variables on the dependent variables were estimated by multiple linear regression analysis.To estimate the diagnostic value of an index,draw the ROC curve.P<0.05 was defined to be statistically significant.ResultsForty-three inpatients with present LVEF between 40-49%were collected.We selected 28 HFmrEF patients from them,containing 18 males and 10 females,with an average age 61 years old.The HFmrEF patients were all suffering from coronary heart disease,among which 11 patients were accompanied with hypertension,3 patients were accompanied with diabetes mellitus,6 patients were accompanied with hypertension and diabetes mellitus.1.Comparison between LVEF40-49%population and controls(1)There are no differences in age,gender,heart rate and blood pressure between two groups(P>0.05).The LVEF40-49%population has a larger BMI(P<0.05).(2)Two-dimensional echocardiography parameters:Compared with controls,the EDV,ESV,LA,LAV,LAVI,IVS,LVEDd,LVPW,LVM,LVMI increase in the LVEF40-49%population(P<0.05);SI,LVEF decrease in the LVEF40-49%population(P<0.05).(3)CDFI parameters:The E,A,E/A show no difference between two groups(P>0.05).(4)TDI parameters:Compared with controls,the e',Sm decrease,E/e' increase in the LVEF40-49%population(P<0.05).(5)2DTT parameters:The GLS is smaller in the LVEF40-49%population(P<0.05).(6)VFM parameters:The EL in left ventricle at every phase decrease in the LVEF40-49%population.The difference at IVR,RFP,IVC,REP is statistically significant(P<0.05).2.Comparison between HFmrEF group and controls(1)There are no differences in age,gender,heart rate and blood pressure between two groups(P>0.05).HFmrEF group has a larger BMI(P<0.05).(2)Two-dimensional echocardiography parameters:Compared with controls,the EDV,ESV,LA,LAV,LAVI,IVS,LVEDd,LVPW,LVM,LVMI increase in theHFmrEF group(P<0.05);SI,LVEF decrease in the HFmrEF group(P<0.05).(3)CDFI parameters:The E,A,E/A show no difference between two groups(P>0.05).(4)TDI parameters:Compared with controls,the e',Sm decrease,E/e' increase in the HFmrEF group(P<0.05).(5)2DTT parameters:The GLS is smaller in the HFmrEF group(P<0.05).(6)VFM parameters:The EL in left ventricle at every phase decrease in the HFmrEF group.The difference at RFP,IVC,REP is statistically significant(P<0.05).3.Comparison between diastolic dysfunction group(group I)and non-diastolic dysfunction group(group II)(1)There are no diffirences in age,gender,BMI,heart rate,blood pressure,NT-proBNP,triglycerides,total cholesterol,HDL-C,LDL-C between two groups(P>0.05),? group has a higher fasting blood glucose(P<0.05).(2)Two-dimensional echocardiography parameters:Compared with group ?,the EDV,ESV,LAV,LAVI,LVEDd of group ? increase(P<0.05).(3)CDFI parameters:E increase in group ?(P<0.05).(4)TDI parameters:E/e' increase in group ?(P<0.05).(5)2DTT parameters:The GLS is smaller in group ?,but with no significant diffirence(P>0.05).(6)VFM parameters:Compared with group ?,the EL of group I at IVR and RFP increase(P<0.05).EL at ACP,IVC and REP decrease,but it's not significantly diffirent.(P>0.05).4.Correlation analysis between EL and echocardiographic data,as well as clinical data in the HFmrEF group(1)In the RFP:the EL of the entire left ventricle is correlated with e'(r=-0.453,P=0.016),E/e'(r=0.456,P=0.015),BMI(r=-0.444,P=0.018),LDL-C(r=-0.476,P=0.016).(2)In the ACP:the EL of the entire left ventricle is correlated with GLS(r=0.392,P=0.039).(3)In the IVC:the EL of the entire left ventricle is correlated with EDV(r=-0.468,P=0.012),ESV(r=-0.468,P=0.012),GLS(r=0.509,P=0.006),BMI(r=-0.382,P=0.045).(4)In the REP:the EL of the entire left ventricle is correlated with EDV(r=-0.419,P=0.026),ESV(r=-0.472,P=0.011),e'(r=-0.392,P=0.039),BMI(r=-0.524,P=0.004).5.Multiple linear regression analysis(1)Total EL in LV during RFP is independently associated with E/e'(?=0.423,P= 0.019),LDL-C(?=-0.418,P= 0.020).(2)Total EL in LV during ACP is associated with GLS(?= 0.392,P= 0.039).(3)Total EL in LV during IVC is independently associated with GLS(?= 0.546,P= 0.001),BMI(?=-0.428,P= 0.009).(4)Total EL in LV during REP is associated with BMI(?=-0.524,P= 0.004).6.ROC analysis for the diagnostic power of EL on HFmrEF AUC=0.817(P<0.05)indicates a good diagnostic efficiency.Conclusion1.The characteristics of HFmrEF patients is systolic dysfunction,accompanied with diastolic dysfunction.2.In HEmrEF,EL within the left ventricle decreases in RFP,IVC,REP.However,the EL in RFP will increase insteadly if accompanied with diastolic dysfunction.3.The EL within the left ventricle in RFP is related to the diastolic function of the heart,and the EL in ACP and IVC is related to the systolic function of the heart. |
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