Sugimoto Tadafumi, Dohi Kaoru, Tanabe Masaki, Watanabe Kiyotaka, Sugiura Emiyo, Nakamori Shiro, Yamada Tomomi, Onishi Katsuya, Nakamura Mashio, Nobori Tsutomu, Ito Masaaki
Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan.
J Echocardiogr. 2013 Mar;11(1):1-8. doi: 10.1007/s12574-012-0142-0. Epub 2012 Aug 23.
We aimed to identify the clinical utility of a simple echocardiographic approach for estimating the pulmonary capillary wedge pressure (PCWP) on the basis of the combined assessment of mitral inflow and tissue Doppler mitral annular velocities.
We retrospectively enrolled 165 patients who underwent both echocardiographic examination and right heart catheterization, and determined the diagnostic accuracy of echocardiography-derived parameters for estimating PCWP >18 mmHg.
Eighty-three patients had preserved left ventricular (LV) ejection fraction ≥50% (the PEF group) and 82 patients had reduced LVEF <50% (the REF group). The PEF group had higher peak early mitral annular velocity (E') compared with the REF group. Eight patients in the PEF group but none in the REF group had normal LV diastolic function, represented as E' >8 cm/s, and all of these patients had normal inflow pattern. The mean PCWP had the strongest correlation with the ratio of the peak early mitral inflow velocity (E) to the peak late diastolic mitral inflow velocity during atrial contraction (E/A) in both groups, followed by the left atrial diameter and E/E' in both patient groups. Receiver operating characteristic (ROC) analysis demonstrated that the combination of abnormal E' ≤8 and elevated E/A had high diagnostic accuracy compared with E/E' in both patient groups with different cutoff values of E/A (1.81 in the PEF group and 1.16 in the REF group) for predicting mean PCWP >18 mmHg.
After excluding patients with normal diastolic function using E', conventional E/A is a reliable marker for predicting high PCWP and is superior to E/E'.
我们旨在确定一种基于二尖瓣血流和组织多普勒二尖瓣环速度联合评估来估算肺毛细血管楔压（PCWP）的简单超声心动图方法的临床实用性。
我们回顾性纳入了165例接受了超声心动图检查和右心导管检查的患者，并确定了超声心动图衍生参数用于估算PCWP>18 mmHg的诊断准确性。
83例患者左心室（LV）射血分数保留≥50%（PEF组），82例患者左心室射血分数降低<50%（REF组）。与REF组相比，PEF组二尖瓣环早期峰值速度（E'）更高。PEF组有8例患者左心室舒张功能正常，表现为E'>8 cm/s，而REF组无此情况，且所有这些患者的血流模式均正常。两组中平均PCWP与二尖瓣早期峰值血流速度（E）与心房收缩期二尖瓣舒张晚期峰值血流速度之比（E/A）的相关性最强，其次是左心房直径和两组患者的E/E'。受试者工作特征（ROC）分析表明，在不同E/A临界值（PEF组为1.81，REF组为1.16）的两组患者中，与E/E'相比，异常E'≤8和升高的E/A组合在预测平均PCWP>18 mmHg方面具有较高的诊断准确性。
在使用E'排除舒张功能正常的患者后，传统的E/A是预测高PCWP的可靠指标，且优于E/E'。
