BACKGROUND Individuals with left ventricular hypertrophy (LVH) and elevated cardiac biomarkers in middle age are at high risk for the development of heart failure with preserved ejection fraction (HFpEF). However, it is unknown what the pathophysiological underpinnings of this high-risk state may be. We tested the hypothesis that patients with LVH and elevated cardiac biomarkers would demonstrate elevated left ventricular (LV) myocardial stiffness in comparison with healthy controls as a key marker for future HFpEF. METHODS Forty-six patients with LVH (LV septum >11 mm) and elevated cardiac biomarkers (N-terminal pro-B-type natriuretic peptide [>40 pg/mL] or troponin T [>0.6 pg/mL]) were recruited, along with 61 age- and sex-matched (by cohort) healthy controls. To define LV pressure-volume relationships, right heart catheterization and 3-dimensional echocardiography were performed while preload was manipulated using lower body negative pressure and rapid saline infusion. RESULTS There were significant differences in body size, blood pressure, and baseline pulmonary capillary wedge pressure between groups (eg, pulmonary capillary wedge pressure: LVH, 13.4±2.7 versus control, 11.7±1.7 mm Hg, P<0.0001). The LV was less distensible in LVH than in controls (smaller volume for the same filling pressure). When preload was expressed as transmural filling pressure (pulmonary capillary wedge pressure - right atrial pressure), LV myocardial stiffness was nearly 30% greater in LVH than in controls (LVH stiffness constant, 0.053±0.027 versus controls, 0.042±0.020, P=0.028). CONCLUSIONS LV myocardial stiffness in patients with LVH and elevated biomarkers (stage-B HFpEF) is greater than in age- and sex-matched controls and thus appears to represent a transitional state from a normal healthy heart to HFpEF. Although the LV myocardial stiffness of patients with LVH is greater than that of healthy controls at this early stage, further studies are required to clarify whether interventions such as exercise training to improve LV compliance may prevent the full manifestation of the HFpEF syndrome in these high-risk individuals. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifiers: NCT03476785 and NCT02039154.

中文翻译：

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高风险左心室肥厚患者的心肌僵硬度增加：B型心力衰竭的保留射血分数的标志。

背景技术中年时患有左心室肥厚（LVH）和心脏生物标志物升高的个体处于心力衰竭发展且射血分数保持不变（HFpEF）的高风险中。但是，尚不清楚这种高风险状态的病理生理基础是什么。我们测试了以下假设：与健康对照组相比，LVH和心脏生物标志物升高的患者将证明左心室（LV）心肌僵硬度升高，这是未来HFpEF的关键标志。方法招募了46例LVH（LV间隔> 11 mm）和心脏生物标志物升高（N端前B型利尿钠肽[> 40 pg / mL]或肌钙蛋白T [> 0.6 pg / mL]）的患者，以及61个年龄和性别相匹配的（按人群）健康对照。要定义LV压力-体积关系，进行右心导管检查和3维超声心动图检查，同时使用下半身负压和快速生理盐水输注预紧力。结果两组之间的体型，血压和基线肺毛细血管楔压之间存在显着差异（例如，肺毛细血管楔压：LVH，13.4±2.7 vs对照组，11.7±1.7 mm Hg，P <0.0001）。与对照组相比，LVH在LVH中的扩张性较小（对于相同的填充压力，体积较小）。当预负荷表示为透壁充盈压（肺毛细血管楔形压力-右心房压）时，LVH的LV心肌刚度比对照组高近30％（LVH刚度常数，相对于对照组，0.053±0.027，0.042±0.020，P = 0.028 ）。结论LVH和生物标志物升高（B期HFpEF）的患者的LV心肌僵硬度大于年龄和性别相匹配的对照组，因此似乎代表了从正常健康心脏到HFpEF的过渡状态。尽管在此早期阶段，LVH患者的左心室心肌僵硬度大于健康对照者，但仍需要进一步研究以阐明诸如锻炼训练以改善左心室顺应性等干预措施是否会阻止这些高危人群中HFpEF综合征的完全表现。冒险的个人。临床试验注册网址：https：//www.clinicaltrials.gov。唯一标识符：NCT03476785和NCT02039154。尽管在此早期阶段，LVH患者的LV心肌僵硬度大于健康对照者，但仍需要进一步研究以阐明诸如锻炼训练以改善LV顺应性等干预措施是否会阻止HFpEF综合征在这些高危人群中的完整表现。冒险的个人。临床试验注册网址：https：//www.clinicaltrials.gov。唯一标识符：NCT03476785和NCT02039154。尽管在此早期阶段，LVH患者的左心室心肌僵硬度大于健康对照者，但仍需要进一步研究以阐明诸如锻炼训练以改善左心室顺应性等干预措施是否会阻止这些高危人群中HFpEF综合征的完全表现。冒险的个人。临床试验注册网址：https：//www.clinicaltrials.gov。唯一标识符：NCT03476785和NCT02039154。