Liang Hsin-Yueh, Cauduro Sanderson A, Pellikka Patricia A, Bailey Kent R, Grossardt Brandon R, Yang Eric H, Rihal Chiranjit, Seward James B, Miller Fletcher A, Abraham Theodore P
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA.
Am J Cardiol. 2006 Mar 15;97(6):866-71. doi: 10.1016/j.amjcard.2005.09.136. Epub 2006 Jan 30.
We sought to determine whether the echocardiographic Doppler parameters of left ventricular diastolic dysfunction predict future heart failure (HF) events and, if so, which parameters best predict HF. We also examined whether the predictive ability of echocardiographic Doppler parameters was related to their prediction of left ventricular end-diastolic pressure (LVEDP). We studied patients who underwent cardiac catheterization and echocardiography performed within a 30-day period. The end point was HF, defined as new-onset or recurrent HF diagnosed by a physician and requiring the initiation or modification of treatment of HF. We identified 289 patients (mean age 63.5 +/- 12.6 years) with a mean follow-up of 10.9 +/- 10.2 months. A total of 24 HF events occurred. LVEDP was a significant predictor of HF univariately and independently in multiple regression models after adjustment for ejection fraction. In Cox models adjusted for age, gender, LVEDP, and ejection fraction, only the left atrial volume index and early mitral inflow to early diastolic tissue velocity (E/e') ratio remained predictive of HF. A multiple regression model, including all echocardiographic variables, showed a persistent, although attenuated, relation of early to late mitral inflow velocity (E/A) ratio and E/e' with LVEDP (p = 0.06 and p = 0.002, respectively). The addition of E/e' or the left atrial volume indexed to body surface area, but not E/A, to the clinical history and left ventricular ejection fraction provided incremental prognostic information. A LVEDP of > or =20 mm Hg, E/e' ratio of > or =15, and left atrial volume index of > or =23 ml/m(2) identified those with a higher risk of HF. In conclusion, invasively determined LVEDP is an independent predictor of future HF events. E/e' and the left atrial volume indexed to body surface area are the best independent predictors of future HF and provide prognostic information incremental to the clinical history and left ventricular ejection fraction.
我们试图确定左心室舒张功能障碍的超声心动图多普勒参数是否能预测未来心力衰竭（HF）事件，如果可以，哪些参数最能预测HF。我们还研究了超声心动图多普勒参数的预测能力是否与其对左心室舒张末期压力（LVEDP）的预测相关。我们研究了在30天内接受心脏导管检查和超声心动图检查的患者。终点为HF，定义为由医生诊断的新发或复发性HF，且需要启动或调整HF治疗。我们确定了289例患者（平均年龄63.5±12.6岁），平均随访时间为10.9±10.2个月。共发生24例HF事件。在调整射血分数后，LVEDP在单因素分析中以及在多元回归模型中均为HF的显著预测因子。在调整年龄、性别、LVEDP和射血分数的Cox模型中，只有左心房容积指数和二尖瓣早期血流速度与舒张早期组织速度（E/e'）比值仍然是HF的预测因子。一个包含所有超声心动图变量的多元回归模型显示，二尖瓣早期与晚期血流速度（E/A）比值和E/e'与LVEDP之间存在持续的（尽管有所减弱）关系（分别为p = 0.06和p = 0.002）。将E/e'或体表面积指数化的左心房容积，而非E/A，加入临床病史和左心室射血分数中可提供额外的预后信息。LVEDP≥20 mmHg、E/e'比值≥15以及体表面积指数化的左心房容积≥23 ml/m²可识别出HF风险较高的患者。总之，通过侵入性方法测定的LVEDP是未来HF事件的独立预测因子。E/e'和体表面积指数化的左心房容积是未来HF的最佳独立预测因子，并可提供超出临床病史和左心室射血分数的预后信息。
