额外的心超变量是否能提高 E/e' 预测正常射血分数左心室充盈压的准确性？一项心超和有创血流动力学研究。
Do additional echocardiographic variables increase the accuracy of E/e' for predicting left ventricular filling pressure in normal ejection fraction? An echocardiographic and invasive hemodynamic study.
机构信息
Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas, USA.
出版信息
J Am Soc Echocardiogr. 2010 Feb;23(2):156-61. doi: 10.1016/j.echo.2009.11.015.
BACKGROUND
There are few data on adding left atrial volume index (LAVi) or pulmonary artery systolic pressure (PAP) to the ratio of early mitral inflow to mitral annular velocity (E/e') for the estimation of left ventricular (LV) filling pressure in patients with preserved LV ejection fractions (LVEFs) (>50%).
METHODS
Patients underwent echocardiography within 20 minutes of cardiac catheterization. Echocardiographic variables were compared with invasively measured LV preatrial contraction pressure (pre-A).
RESULTS
Of the 122 patients studied (mean age, 55 +/- 9 years; mean LVEF, 61 +/- 6%), 67 (55%) were women, 108 (88%) had hypertension, and 79 (65%) had significant coronary artery disease at catheterization. E/e' was significantly correlated with pre-A (R = 0.63, P < .0001) compared with LAVi (R = 0.49, P < .001) and PAP (R = 0.48, P < .001). E/e' > 13 had sensitivity of 70% and specificity of 93% (area under the curve [AUC], 0.82; P < .0001), LAVi > 31 mL/m2 had sensitivity of 78% and specificity of 76% (AUC, 0.80, P < .001), and PAP > 28 mm Hg had sensitivity of 80% and specificity of 64% for pre-A > 15 mm Hg (AUC, 0.77, P < .001). Adding LAVi >31 mL/m2 for E/e' = 8 to 13 significantly increased the accuracy of E/e' > 13 alone (sensitivity, 87%; specificity, 88%; AUC, 0.89; P = .01 for comparison). However, adding PAP > 28 mm Hg for E/e' = 8 to 13 did not significantly increase the accuracy of E/e' > 13 alone (AUC, 0.82; sensitivity, 82%; specificity, 72%; P = NS for comparison).
CONCLUSIONS
In patients with preserved LVEFs, adding LAVi > 31 mL/m2 to E/e' (when E/e' was in the gray zone, but not when E/e' was >13) significantly increased the accuracy of E/e' alone for the estimation of LV filling pressure. These data support the notion of using several, rather than any single, Doppler echocardiographic parameter for the accurate assessment of LV diastolic function.
背景
在射血分数保留（LVEF＞50%）的患者中，将左心房容积指数（LAVi）或肺动脉收缩压（PAP）与早期二尖瓣流入速度与二尖瓣环速度之比（E/e'）联合应用以估计左心室充盈压的相关数据较少。
方法
患者在心脏导管插入术 20 分钟内接受超声心动图检查。将超声心动图变量与经导管测量的左心房收缩前压（pre-A）进行比较。
结果
在 122 例研究患者中（平均年龄 55±9 岁；平均 LVEF 61±6%），67 例（55%）为女性，108 例（88%）患有高血压，79 例（65%）在导管插入术时存在明显的冠状动脉疾病。与 LAVi（R = 0.49，P＜0.001）和 PAP（R = 0.48，P＜0.001）相比，E/e'与 pre-A 的相关性更高（R = 0.63，P＜0.0001）。E/e'＞13 时的敏感性为 70%，特异性为 93%（曲线下面积[AUC]，0.82；P＜0.0001），LAVi＞31mL/m2 时的敏感性为 78%，特异性为 76%（AUC，0.80，P＜0.001），PAP＞28mmHg 时的敏感性为 80%，特异性为 64%，适用于 pre-A＞15mmHg（AUC，0.77，P＜0.001）。E/e'=8-13 时，E/e'＞13 时加入 LAVi＞31mL/m2 显著提高了准确性（敏感性 87%，特异性 88%，AUC 0.89；与比较，P=0.01）。然而，E/e'=8-13 时加入 PAP＞28mmHg 并没有显著提高 E/e'＞13 时的准确性（AUC 0.82；敏感性 82%，特异性 72%；与比较，P=NS）。
结论
在 LVEF 保留的患者中，E/e'（E/e'处于灰色区域时，但不是 E/e'＞13 时）联合 LAVi＞31mL/m2 可显著提高 E/e'单独评估左心室充盈压的准确性。这些数据支持使用多个而非任何单个多普勒超声心动图参数来准确评估左心室舒张功能的观点。
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