University of Michigan, Ann Arbor, MI.
J Card Fail. 2010 Jan;16(1):69-75. doi: 10.1016/j.cardfail.2009.08.004. Epub 2009 Sep 26.
The estimation of left ventricular filling pressure (LVFP) remains a critical component in the management of patients with known or suspected acute heart failure syndromes. Although right heart catheterization (RHC) remains the gold standard, several noninvasive parameters, including clinical assessment, B-type natriuretic peptides (BNP), and echocardiography can approximate LVFP. We sought to use a combination of these measures to noninvasively predict high or low LVFP in a population referred for RHC.
The study consisted of validation of hand-carried ultrasound (HCU)-derived measurement of mitral E/E' against standard echocardiograms in 50 patients, as well as direct comparison of jugular venous pressure (JVP), a clinical congestion score, HCU-derived E/E' and maximum inferior vena cava diameter (IVCmax), and BNP with pulmonary capillary wedge pressure (PCWP) in another 50 patients. The mean age was 61 years, ejection fraction 40%, JVP 9 cm, BNP 948 pg/mL, IVCmax 2.1 cm, E/E' 13, and PCWP 21. All parameters performed well in determining PCWP >or=15 mm Hg, with clinical score performing the worst (area under the receiver-operator characteristic curve [AUC] 0.74), and IVCmax performing the best (AUC 0.89). JVP, in combination with HCU-derived parameters and BNP performed better than any of the individual tests alone (AUC 0.97 for combination of all 3).
Clinical score, JVP, HCU indices, and BNP perform well at identifying patients with a PCWP >or=15 mm Hg. Use of these indices alone or in combination can be used to identify and potentially monitor patients with high LVFP in the inpatient and outpatient settings.
左心室充盈压（LVFP）的估测在已知或疑似急性心力衰竭综合征患者的治疗中仍然是一个关键组成部分。尽管右心导管检查（RHC）仍然是金标准，但包括临床评估、B 型利钠肽（BNP）和超声心动图在内的几种非侵入性参数也可以近似 LVFP。我们试图使用这些措施的组合，对接受 RHC 的人群进行无创预测 LVFP 高低。
该研究包括在 50 例患者中验证手提式超声（HCU）衍生的二尖瓣 E/E'与标准超声心动图的测量，以及在另外 50 例患者中直接比较颈静脉压（JVP）、临床充血评分、HCU 衍生的 E/E'和最大下腔静脉直径（IVCmax）和 BNP 与肺毛细血管楔压（PCWP）。患者的平均年龄为 61 岁，射血分数为 40%，JVP 为 9cm，BNP 为 948pg/ml，IVCmax 为 2.1cm，E/E'为 13，PCWP 为 21mmHg。所有参数在确定 PCWP≥15mmHg 方面表现良好，临床评分表现最差（受试者工作特征曲线下面积[AUROC]为 0.74），而 IVCmax 表现最好（AUROC 为 0.89）。JVP 与 HCU 衍生参数和 BNP 联合应用优于任何单一测试（联合应用所有 3 种参数的 AUROC 为 0.97）。
临床评分、JVP、HCU 指数和 BNP 可很好地识别 PCWP≥15mmHg 的患者。单独或联合使用这些指标可用于识别和潜在监测住院和门诊环境中 LVFP 较高的患者。
