Background: Influence of right ventricular diastolic function on the hemodynamics of heart failure (HF). We aimed to clarify the hemodynamic features of deep Y descent in the right atrial pressure waveform in patients with HF and preserved left ventricular systolic function.

Methods: In total, 114 consecutive inpatients with HF who had preserved left ventricular systolic function (left ventricular ejection fraction ≥ 50%) and right heart catheterization were retrospectively enrolled in this study. The patients were divided into two groups according to right atrial pressure waveform, and those with Y descent deeper than X descent in the right atrial pressure waveform were assigned to the deep Y descent group. We enrolled another seven patients (two men, five women; mean age, 87 ± 6) with HF and preserved ejection fraction, and implanted a pacemaker to validate the results of this study.

Results: The patients with deep Y descent had a higher rate of atrial fibrillation, higher right atrial pressure and mean pulmonary arterial pressure, and lower stroke volume and cardiac index than those with normal Y descent (76 vs. 7% p < 0.001, median 8 vs. 5 mmHg p = 0.001, median 24 vs. 21 mmHg p = 0.036, median 33 vs. 43 ml/m²p < 0.001, median 2.2 vs. 2.7 L/m², p < 0.001). Multiple linear regression revealed a negative correlation between stroke volume index and pulmonary vascular resistance index (wood unit*m²) only in the patients with deep Y descent (estimated regression coefficient: −1.281, p = 0.022). A positive correlation was also observed between cardiac index and heart rate in this group (r = 0.321, p = 0.038). In the other seven patients, increasing the heart rate (from median 60 to 80/min, p = 0.001) significantly reduced the level of BNP (from median 419 to 335 pg/ml, p = 0.005).

Conclusions: The hemodynamics of patients with HF with deep Y descent and preserved left ventricular systolic function resembled right ventricular restrictive physiology. Optimizing the heart rate may improve hemodynamics in these patients.

背景：右心室舒张功能对心力衰竭（HF）血流动力学的影响。我们旨在阐明左心室收缩功能保留的 HF 患者右心房压力波形中深 Y 下降的血流动力学特征。

方法：总共有 114 名连续住院且左心室收缩功能保留（左心室射血分数 ≥ 50%）和右心导管插入术的 HF 患者被纳入本研究。根据右房压波形将患者分为两组，将右房压波形中Y下降比X下降更深的患者分配到深Y下降组。我们招募了另外 7 名射血分数保留的 HF 患者（2 名男性，5 名女性；平均年龄为 87 ± 6 岁），并植入了起搏器以验证本研究的结果。

结果： 与正常 Y 下降的患者相比，深 Y 下降患者的房颤发生率更高，右心房压力和平均肺动脉压更高，每搏输出量和心脏指数更低（76% vs. 7%） p < 0.001，中位数 8 与 5 mmHg p = 0.001，中位数 24 与 21 mmHg p= 0.036，中位数 33 对 43 ml/m ²p< 0.001，中值 2.2 与 2.7 L/m ²，p< 0.001)。多元线性回归显示，仅在深 Y 下降患者中，每搏输出量指数与肺血管阻力指数（木材单位*m ²）呈负相关（估计回归系数：-1.281，p= 0.022）。在该组中还观察到心脏指数与心率之间呈正相关（r = 0.321，p= 0.038）。在其他 7 名患者中，心率增加（从中位数 60 到 80/分钟，p = 0.001) 显着降低 BNP 水平（从中位数 419 到 335 pg/ml， p = 0.005）。

结论：具有深 Y 下降和保留左心室收缩功能的 HF 患者的血流动力学类似于右心室限制性生理学。优化心率可能会改善这些患者的血流动力学。