床旁组织多普勒超声心动图和B型利钠肽（BNP）在鉴别左心室射血分数正常且患有永久性非瓣膜性心房颤动的老年患者急性呼吸困难的充血性心力衰竭与非心脏病因中的作用：一项前瞻性单中心研究的见解

Usefulness of bedside tissue Doppler echocardiography and B-type natriuretic peptide (BNP) in differentiating congestive heart failure from noncardiac cause of acute dyspnea in elderly patients with a normal left ventricular ejection fraction and permanent, nonvalvular atrial fibrillation: insights from a prospective, monocenter study.

作者信息

Arques Stephane, Roux Emmanuel, Sbragia Pascal, Pieri Bertrand, Gelisse Richard, Luccioni Roger, Ambrosi Pierre

机构信息

Department of Cardiology, Aubagne Hospital, Aubagne, France.

出版信息

Echocardiography. 2007 May;24(5):499-507. doi: 10.1111/j.1540-8175.2007.00418.x.

DOI:10.1111/j.1540-8175.2007.00418.x

PMID:17456069

Abstract

BACKGROUND

The incremental role of bedside tissue Doppler echocardiography and B-type natriuretic peptide (BNP) over the clinical judgment has been recently reported in the emergency diagnosis of congestive heart failure with a normal left ventricular ejection fraction (HFNEF). However, how well does this diagnostic strategy be applicable in the setting of atrial fibrillation is unknown.

OBJECTIVE

To investigate the usefulness of bedside tissue Doppler echocardiography and BNP in the emergency diagnosis of HFNEF in elderly patients with permanent, nonvalvular atrial fibrillation.

METHODS

Forty-one consecutive elderly patients with an ejection fraction > or =50% (mean age 84 years; 22 with HFNEF and 19 with noncardiac cause), hospitalized for acute dyspnea at rest, were prospectively enrolled; bedside septal E/Ea and BNP were obtained at admission.

RESULTS

By multivariable logistic regression analysis including the clinical judgment of heart failure, E/Ea and BNP, E/Ea (P = 0.014) and BNP (P = 0.018) provided independent diagnostic information. Optimal cutoffs were 13 for E/Ea (area under the ROC curve of 0.846, P < 0.0001; sensitivity 81.8%, specificity 89.5%) and 253 pg/ml for BNP (area under the ROC curve of 0.928, P < 0.0001; sensitivity 86.4%, specificity 89.5%). The concordance between the clinical judgment and BNP concentration at the cutoff of 253 pg/ml correctly classified 24 of 25 patients; E/Ea at the cutoff of 13 correctly classified 14 of the 16 patients with discrepancy.

CONCLUSION

Bedside tissue Doppler echocardiography and BNP provide useful additional diagnostic information over the clinical judgment for the emergency diagnosis of HFNEF in elderly patients with permanent, nonvalvular atrial fibrillation.

摘要

背景

最近有报道称，床旁组织多普勒超声心动图和B型利钠肽（BNP）在左心室射血分数正常的充血性心力衰竭（HFNEF）的急诊诊断中，相对于临床判断具有增量作用。然而，这种诊断策略在房颤背景下的适用程度尚不清楚。

目的

探讨床旁组织多普勒超声心动图和BNP在老年永久性非瓣膜性房颤患者HFNEF急诊诊断中的作用。

方法

前瞻性纳入41例因静息时急性呼吸困难住院的老年患者，射血分数≥50%（平均年龄84岁；22例为HFNEF，19例为非心脏原因）；入院时获取床旁室间隔E/Ea和BNP。

结果

通过多变量逻辑回归分析，包括心力衰竭的临床判断、E/Ea和BNP，E/Ea（P = 0.014）和BNP（P = 0.018）提供了独立的诊断信息。E/Ea的最佳截断值为13（ROC曲线下面积为0.846，P < 0.0001；敏感性81.8%，特异性89.5%），BNP的最佳截断值为253 pg/ml（ROC曲线下面积为0.928，P < 0.0001；敏感性为86.4%，特异性为89.5%）。临床判断与BNP浓度在253 pg/ml截断值时的一致性正确分类了25例患者中的24例；E/Ea在13的截断值时正确分类了16例有差异患者中的14例。