Dokainish Hisham, Nguyen John S, Bobek Jaromir, Goswami Rajiv, Lakkis Nasser M
Division of Cardiology, Department of Medicine, McMaster University Health Sciences Centre, 237 Barton Street E., Hamilton, ON, Canada.
Eur J Echocardiogr. 2011 Nov;12(11):857-64. doi: 10.1093/ejechocard/jer157. Epub 2011 Sep 1.
There is controversy surrounding the accuracy of echo-Doppler variables, including early mitral inflow/mitral annular velocity (E/e'), for estimating left ventricular filling pressure (LVFP) in patients with depressed ejection fraction (EF < 50%).
The American Society of Echocardiography-European Association of Echocardiography (ASE-EAE) algorithm for diastolic function in depressed LVEF was retrospectively applied to a database of patients who underwent echocardiography ≤20 min of cardiac catheterization. LV pre-atrial contraction pressure (pre-A) ≥15 mmHg was elevated. Of 62 patients studied, the mean age was 53.6 ± 10.6 years and the mean LVEF was 27.2 ± 11.8%. The correlations of E/e' (R = 0.43, P = 0.0005) and E (R = 0.39, P = 0.002) with LV pre-A were modest, compared with pulmonary artery pressure (PAP, R = 0.69, P = 0.0006), E/late mitral (A) velocity (R = 0.52, P < 0.0001), and mitral deceleration time (DT, R = -0.51, P < 0.0001). Using the ASE-ESE algorithm starting with E/A, E, and DT, 54 of 62 patients were accurately classified to predict LV pre-A >15 or <15 mmHg (sensitivity = 84%, specificity = 80%, area under the curve = 0.86, P < 0.001). The 6 of 6 patients with E/A < 1 and E < 50 and the 14 of 15 (93%) patients with E/A> 2 and DT < 150 were correctly classified as having normal and elevated LVFP, respectively, while 34 of 41 (83%) patients with E/A = 1-2 or E/A<1 and E>50 cm/s were correctly classified using the addition of E/e' and PAP.
This retrospective study shows that in this population with depressed LVEF, no single echo-Doppler variable had high accuracy for predicting LV pre-A ≥15 mmHg. However, the ASE-EAE algorithm using multiple variables predicted LVFP with good accuracy, superior to any single echo-Doppler variable alone.
对于射血分数降低（EF<50%）的患者，包括早期二尖瓣血流/二尖瓣环速度（E/e'）在内的超声多普勒变量在估计左心室充盈压（LVFP）方面的准确性存在争议。
将美国超声心动图学会-欧洲超声心动图协会（ASE-EAE）针对左心室射血分数降低患者舒张功能的算法回顾性应用于在心脏导管插入术≤20分钟内接受超声心动图检查的患者数据库。左心房收缩前压力（pre-A）≥15 mmHg即为升高。在研究的62例患者中，平均年龄为53.6±10.6岁，平均左心室射血分数为27.2±11.8%。与肺动脉压（PAP，R = 0.69，P = 0.0006）、E/二尖瓣晚期（A）速度（R = 0.52，P<0.0001）和二尖瓣减速时间（DT，R = -0.51，P<0.0001）相比，E/e'（R = 0.43，P = 0.0005）和E（R = 0.39，P = 0.002）与左心室pre-A的相关性中等。使用从E/A、E和DT开始的ASE-ESE算法，62例患者中有54例被准确分类以预测左心室pre-A>15或<15 mmHg（敏感性=84%，特异性=80%，曲线下面积=0.86，P<0.001）。6例E/A<1且E<50的患者和15例E/A>2且DT<150的患者中的14例（93%）分别被正确分类为左心室充盈压正常和升高，而41例E/A = 1-2或E/A<1且E>50 cm/s的患者中有34例（83%）通过添加E/e'和PAP被正确分类。
这项回顾性研究表明，在这个左心室射血分数降低的人群中，没有单一的超声多普勒变量在预测左心室pre-A≥15 mmHg方面具有高准确性。然而，使用多个变量的ASE-EAE算法预测左心室充盈压具有良好的准确性，优于任何单独的单一超声多普勒变量。
