Cedars-Sinai Heart Institute, Los Angeles, California, USA.
Am J Cardiol. 2012 Sep 1;110(5):689-94. doi: 10.1016/j.amjcard.2012.04.055. Epub 2012 May 25.
Multiple echocardiographic criteria are routinely used for the estimation of left heart filling pressures. We assessed the predictive value of various echocardiographic parameters to estimate the left heart filling pressure and proposed a simplified approach for its evaluation. We collected the clinical, echocardiographic, and invasive hemodynamic data from 93 patients with heart failure who underwent right-sided heart catheterization and transthoracic echocardiography within a 24-hour period. Of these 93 patients, 57% had a left ventricular ejection fraction <50% and 69% had an elevated mean pulmonary capillary wedge pressure of ≥ 15 mm Hg. A mitral E/E' of ≥ 15 had a sensitivity of 55% but a specificity of 96%. A left atrial area of ≥ 20 cm(2) had a sensitivity of 66% and specificity of 89%. A deceleration time <140 ms had a sensitivity of 51% and specificity of 93% to predict a pulmonary capillary wedge pressure of ≥ 15 mm Hg. The combination of E/E' ≥ 15 ± left atrial area of ≥ 20 cm(2) ± deceleration time <140 ms provided a sensitivity of 92% and specificity of 85%. On multivariate analysis, the combination of E/E' ≥ 15, left atrial area of ≥ 20 cm(2), and deceleration time <140 ms was the most significant predictor of a pulmonary capillary wedge pressure of ≥ 15 mm Hg (odds ratio 48, 95% confidence interval 10 to 289, p <0.001). In conclusion, this simplified approach using 3 echocardiographic parameters provides an accurate and a practical approach for the routine estimation of the elevated left heart filling pressure.
多种超声心动图标准常用于左心充盈压的估计。我们评估了各种超声心动图参数预测左心充盈压的价值，并提出了一种简化的评估方法。我们收集了 93 例心力衰竭患者的临床、超声心动图和有创血流动力学数据，这些患者在 24 小时内接受了右侧心导管检查和经胸超声心动图检查。在这 93 例患者中，57%的左心室射血分数<50%，69%的平均肺动脉楔压升高≥15mmHg。二尖瓣 E/E'≥15 的敏感性为 55%，特异性为 96%。左心房面积≥20cm(2)的敏感性为 66%，特异性为 89%。减速时间<140ms 的敏感性为 51%，特异性为 93%，可预测肺动脉楔压≥15mmHg。E/E'≥15±左心房面积≥20cm(2)±减速时间<140ms 的联合检测可提供 92%的敏感性和 85%的特异性。多变量分析显示，E/E'≥15、左心房面积≥20cm(2)和减速时间<140ms 的联合检测是预测肺动脉楔压≥15mmHg 的最显著预测因子(比值比 48，95%置信区间 10 至 289，p<0.001)。总之，这种使用 3 个超声心动图参数的简化方法为常规估计升高的左心充盈压提供了一种准确、实用的方法。
