用于评估左心室射血分数正常的心脏病患者充盈压的新型简易超声心动图指标。
New, simple echocardiographic indexes for the estimation of filling pressure in patients with cardiac disease and preserved left ventricular ejection fraction.
作者信息
Dokainish Hisham, Nguyen John, Sengupta Ranjita, Pillai Manu, Alam Mahboob, Bobek Jaromir, Lakkis Nasser
机构信息
Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, TX, USA.
出版信息
Echocardiography. 2010 Sep;27(8):946-53. doi: 10.1111/j.1540-8175.2010.01177.x.
BACKGROUND
There are few data on echocardiographic indexes incorporating peak mitral inflow velocity (E), left atrial volume index (LAVi), and pulmonary artery pressure (PAP) for estimation of left ventricular (LV) filling pressure in patients with preserved LV ejection fraction (EF ≥ 50%).
METHODS
Patients underwent echocardiography ≤20 minutes of cardiac catheterization. Echocardiographic variables were compared to invasively measured LV end-diastolic pressure (LVEDP).
RESULTS
Of the 122 patients, 67 (55%) were women, the mean age was 55 ± 9 years, the mean left ventricular ejection fraction (LVEF) was 61 ± 6%, 107 (88%) were hypertensive, and 79 (65%) had significant coronary artery disease at catheterization. E/Ea correlated with LVEDP (R = 0.68, P < 0.0001), compared to PAP (R = 0.53, P < 0.001), peak E velocity (R = 0.48, P < 0.001), and LAVi (R = 0.48, P < 0.001). E/Ea > 12 had 75% sensitivity and 78% specificity for LVEDP ≥ 20 mmHg (area under curve (AUC) = 0.79, P < 0.0001), compared with (PAP + LAVi)/2 > 30 (sensitivity = 72%, specificity = 80%, AUC = 0.84, P < 0.001) and (E + LAVi)/2 > 57 (sensitivity = 73% and specificity = 81%, AUC = 0.82, P < 0.001) (P = NS). E <60 cm/sec had 94% negative, and E>90 cm/sec had 96% positive, predictive value for LVEDP ≥ 20 mmHg. (E + LAVi)/2 added incrementally to E/Ea when E/Ea was in the gray zone.
CONCLUSIONS
New, simple echocardiographic equations, (E + LAVi)/2 and (PAP + LAVi)/2, have comparable accuracy to E/Ea for LVEDP estimation in patients with cardiac disease and preserved LVEF, and (E + LAVi)/2 added incrementally to E/Ea alone when E/Ea was in the gray zone. Peak E velocity alone had high negative and positive predictive value for elevated LVEDP in this population. These simple echocardiographic variables could be used-in isolation or with E/Ea-in patients with cardiac disease and preserved LVEF for the diagnosis of diastolic heart failure.
背景
关于结合二尖瓣血流峰值速度（E）、左心房容积指数（LAVi）和肺动脉压（PAP）来评估左心室射血分数保留（EF≥50%）患者左心室（LV）充盈压的超声心动图指标的数据较少。
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有创测量的左心室舒张末期压力（LVEDP）进行比较。
结果
122例患者中，67例（55%）为女性，平均年龄为55±9岁，平均左心室射血分数（LVEF）为61±6%，107例（88%）为高血压患者，79例（65%）在导管插入术时有显著冠状动脉疾病。E/Ea与LVEDP相关（R = 0.68，P < 0.0001），与PAP（R = 0.53，P < 0.001）、E峰值速度（R = 0.48，P < 0.001）和LAVi（R = 0.48，P < 0.001）相比。对于LVEDP≥20 mmHg，E/Ea>12的敏感度为75%，特异度为78%（曲线下面积（AUC） = 0.79，P < 0.0001），与（PAP + LAVi）/2>30（敏感度 = 72%，特异度 = 80%，AUC = 0.84，P < 0.001）和（E + LAVi）/2>57（敏感度 = 73%，特异度 = 81%，AUC = 0.82，P < 0.001）相比（P = 无显著差异）。E<60 cm/秒对LVEDP≥20 mmHg的阴性预测值为94%，E>90 cm/秒的阳性预测值为96%。当E/Ea处于灰色区域时，（E + LAVi）/2可逐步添加到E/Ea中。
结论
新的、简单的超声心动图方程（E + LAVi）/2和（PAP + LAVi）/2在评估心脏病和LVEF保留患者的LVEDP方面与E/Ea具有相当的准确性，并且当E/Ea处于灰色区域时，（E + LAVi）/2可单独逐步添加到E/Ea中。仅E峰值速度对该人群中升高的LVEDP具有较高的阴性和阳性预测值。这些简单的超声心动图变量可单独使用或与E/Ea一起用于心脏病和LVEF保留患者舒张性心力衰竭的诊断。
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