定量超声心动图预测心力衰竭住院和死亡：是否选择体表面积作为索引方法？心脏与灵魂研究。
Predicting heart failure hospitalization and mortality by quantitative echocardiography: is body surface area the indexing method of choice? The Heart and Soul Study.
机构信息
California Pacific Medical Center, San Francisco, California 94115, USA.
出版信息
J Am Soc Echocardiogr. 2010 Apr;23(4):406-13. doi: 10.1016/j.echo.2010.01.019. Epub 2010 Mar 3.
BACKGROUND
Echocardiographic measurements of left ventricular (LV) mass, left atrial (LA) volume, and LV end-systolic volume (ESV) predict heart failure (HF) hospitalization and mortality. Indexing measurements by body size is thought to establish limits of normality among individuals varying in body habitus. The American Society of Echocardiography recommends dividing measurements by body surface area (BSA), but others have advocated alternative indexing methods.
METHODS
Echocardiographic measurements were collected in 1024 ambulatory adults with coronary artery disease. LV mass, LA volume, and LV ESV were calculated using truncated ellipse method and biplane method of disk formulae. Comparison between raw measurements and measurements divided by indexing parameters was made by hazard ratios per standard deviation increase in variable and c-statistics for BSA, BSA(0.43), BSA(1.5), height, height(0.25), height(2), height(2.7), body weight (BW), BW(0.26), body mass index (BMI), and BMI(0.27).
RESULTS
Mean LV mass was 192 +/- 57 g, mean LA volume was 65 +/- 24 mL, and mean LV ESV was 41 +/- 26 mL. Average height was 171 +/- 9 cm, average BSA was 1.94 +/- 0.22 m(2), and average BMI was 28.4 +/- 5.3 kg/m(2). At an average follow-up of 5.6 +/- 1.8 years, there were 148 HF hospitalizations, 71 cardiovascular (CV) deaths, and 269 all-cause deaths. There was excellent correlation between raw measurements and those indexed by height (r = 0.98-0.99), and moderate correlation between raw measurements and those indexed by BW (r = 0.73-0.94). C-statistics and hazard ratios per standard deviation increase in indexed variables were similar for HF hospitalization, CV mortality, and all-cause mortality. There were no significant differences among indexing methods in ability to predict outcomes.
CONCLUSION
The choice of indexing method by parameters of BSA, height, BW, and BMI does not affect the clinical usefulness of LV mass, LA volume, and LV ESV in predicting HF hospitalization, CV mortality, or all-cause mortality among ambulatory adults with coronary artery disease. Continued use of BSA to index measurements of LV mass, LA volume, and LV ESV is acceptable.
背景
左心室（LV）质量、左心房（LA）容积和 LV 收缩末期容积（ESV）的超声心动图测量值可预测心力衰竭（HF）住院和死亡率。通过身体大小对测量值进行指数化，被认为可以在体型不同的个体中建立正常范围的界限。美国超声心动图学会建议通过体表面积（BSA）进行测量，但也有人提倡使用其他索引方法。
方法
对 1024 例有冠心病的门诊成年人进行超声心动图测量。使用截断椭圆法和双平面碟形公式法计算 LV 质量、LA 容积和 LV ESV。通过变量每标准差增加的危险比和 BSA、BSA(0.43)、BSA(1.5)、身高、身高(0.25)、身高(2)、身高(2.7)、体重、体重(0.26)、体重指数和 BMI(0.27)的 C 统计量对原始测量值和按索引参数划分的测量值进行比较。
结果
平均 LV 质量为 192±57g，平均 LA 容积为 65±24mL，平均 LV ESV 为 41±26mL。平均身高为 171±9cm，平均 BSA 为 1.94±0.22m²，平均 BMI 为 28.4±5.3kg/m²。在平均 5.6±1.8 年的随访中，有 148 例 HF 住院，71 例心血管（CV）死亡，269 例全因死亡。原始测量值与身高指数（r=0.98-0.99）之间存在极好的相关性，与体重指数（r=0.73-0.94）之间存在中度相关性。HF 住院、CV 死亡率和全因死亡率的指数变量的 C 统计量和每标准差增加的危险比相似。在预测结果的能力方面，各指数方法之间没有显著差异。
结论
BSA、身高、体重和 BMI 参数的索引方法选择不会影响超声心动图测量的 LV 质量、LA 容积和 LV ESV 在预测有冠心病的门诊成年人 HF 住院、CV 死亡率或全因死亡率方面的临床实用性。继续使用 BSA 来索引 LV 质量、LA 容积和 LV ESV 的测量值是可以接受的。
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