心音心电图左心室收缩时间间期及B型利钠肽水平在左心室功能障碍诊断中的应用
Performance of phonoelectrocardiographic left ventricular systolic time intervals and B-type natriuretic peptide levels in the diagnosis of left ventricular dysfunction.
作者信息
Moyers Brian, Shapiro Mia, Marcus Gregory M, Gerber Ivor L, McKeown Barry H, Vessey Joshua C, Jordan Mark V, Huddleston Michele, Foster Elyse, Chatterjee Kanu, Michaels Andrew D
机构信息
Division of Cardiology, Department of Medicine, University of California at San Francisco Medical Center, San Francisco, CA, USA.
出版信息
Ann Noninvasive Electrocardiol. 2007 Apr;12(2):89-97. doi: 10.1111/j.1542-474X.2007.00146.x.
BACKGROUND
Systolic time intervals measured by echocardiography and carotid artery tracings are validated methods of assessing left ventricular function. However, the clinical utility of phonoelectrocardiographic systolic time intervals for predicting heart failure using newer technology has not been evaluated.
METHODS
We enrolled 100 adult patients undergoing left heart catheterization. Participants underwent computerized phonoelectrocardiographic analysis, left ventricular end-diastolic pressure (LVEDP) measurement, transthoracic echocardiographic measurement of left ventricular ejection fraction (LVEF), and B-type natriuretic peptide (BNP) testing. The heart rate-adjusted systolic time intervals included the time from the Q wave onset to peak S1 (electromechanical activation time, EMAT), Q wave onset to peak S2 (electromechanical systole, Q-S2), and peak S1 to peak S2 (left ventricular systolic time, LVST). Left ventricular dysfunction was defined as the presence of both LVEDP >15 mmHg and LVEF <50%.
RESULTS
EMAT (r =-0.51; P < 0.0001), EMAT/LVST (r =-0.41; P = 0.0001), and Q-S2 (r =-0.39; P = 0.0003) correlated with LVEF, but not with LVEDP. An abnormal EMAT > or =15 (odds ratio 1.38, P < 0.0001) and EMAT/LVST > or =0.40 (OR 1.13, P = 0.002) were associated with left ventricular dysfunction. EMAT > or =15 had 44% sensitivity, 94% specificity, and a 7.0 likelihood ratio for left ventricular dysfunction, while EMAT/LVST > or =0.40 had 55% sensitivity, 95% specificity, and a 11.7 likelihood ratio. In patients with an intermediate BNP (100-500 pg/mL), the likelihood ratio increased from 1.1 using the BNP result alone to 11.0 when adding a positive EMAT test for predicting left ventricular dysfunction.
CONCLUSIONS
Phonoelectrocardiographic measures of systolic time intervals are insensitive but highly specific tests for detecting abnormalities in objective markers of left ventricular function. EMAT and EMAT/LVST provide diagnostic information independent of BNP for detecting patients with left ventricular dysfunction.
背景
通过超声心动图和颈动脉描记术测量的收缩期时间间期是评估左心室功能的有效方法。然而，使用更新技术的心电图收缩期时间间期在预测心力衰竭方面的临床实用性尚未得到评估。
方法
我们纳入了100例接受左心导管检查的成年患者。参与者接受了计算机化心电图分析、左心室舒张末期压力（LVEDP）测量、经胸超声心动图测量左心室射血分数（LVEF）以及B型利钠肽（BNP）检测。心率校正的收缩期时间间期包括从Q波起始到S1峰的时间（电机械激活时间，EMAT）、Q波起始到S2峰的时间（电机械收缩期，Q-S2）以及S1峰到S2峰的时间（左心室收缩期时间，LVST）。左心室功能障碍定义为LVEDP>15 mmHg且LVEF<50%。
结果
EMAT（r = -0.51；P < 0.0001）、EMAT/LVST（r = -0.41；P = 0.0001）和Q-S2（r = -0.39；P = 0.0003）与LVEF相关，但与LVEDP无关。异常的EMAT≥15（比值比1.38，P < 0.0001）和EMAT/LVST≥0.40（OR 1.13，P = 0.002）与左心室功能障碍相关。EMAT≥15对左心室功能障碍的敏感性为44%，特异性为94%，似然比为7.0，而EMAT/LVST≥0.40的敏感性为55%，特异性为95%，似然比为11.7。在BNP处于中等水平（100 - 500 pg/mL）的患者中，预测左心室功能障碍时，似然比从仅使用BNP结果时的1.1增加到添加阳性EMAT检测时的11.0。
结论
心电图收缩期时间间期测量对于检测左心室功能客观标志物异常是不敏感但高度特异的检查。EMAT和EMAT/LVST提供了独立于BNP的诊断信息，用于检测左心室功能障碍患者。
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