E 波减速率 E/DT 优于组织多普勒衍生指数 E/e'，可用于特征心力衰竭保留射血分数患者的肺重构。

The E-wave deceleration rate E/DT outperforms the tissue Doppler-derived index E/e' in characterizing lung remodeling in heart failure with preserved ejection fraction.

机构信息

Department of Cardiothoracic Surgery, Jena University Hospital - Friedrich Schiller University Jena, Jena, Germany.

出版信息

PLoS One. 2013 Dec 3;8(12):e82077. doi: 10.1371/journal.pone.0082077. eCollection 2013.

BACKGROUND

Diastolic dysfunction in heart failure with preserved ejection fraction (HFpEF) may result in pulmonary congestion and lung remodeling. We evaluated the usefulness of major diastolic echocardiographic parameters and of the deceleration rate of early transmitral diastolic velocity (E/DT) in predicting lung remodeling in a rat model of HFpEF.

METHODS AND RESULTS

Rats underwent aortic banding (AoB) to induce pressure overload (PO). Left ventricular hypertrophy fully developed 2 weeks after AoB. At 4 and 6 weeks, the lung weight-to-body weight ratio (LW/BW), a sensitive marker for pulmonary congestion and remodeling, dramatically increased despite preserved fractional shortening, indicating the presence of HFpEF. The time course of LW/BW was well reflected by E/DT, by the ratio of early to late transmitral diastolic velocity (E/A) and the deceleration time of E (DT), but not by the ratio of transmitral to mitral annular early diastolic velocity (E/e'). In agreement, the best correlation with LW/BW was found for E/DT (r = 0.76; p<0.0001), followed by E/A (r = 0.69; p<0.0001), DT (r = -0.62; p<0.0001) and finally E/e' (r = 0.51; p<0.001). Furthermore, analysis of receiver-operating characteristic curves for the prediction of increased LW/BW revealed excellent area under the curve values for E/DT (AUC = 0.98) and DT (AUC = 0.95), which are significantly higher than that of E/e' (AUC = 0.82). In a second approach, we also found that the new parameter E/DT correlated well with right ventricular weight index and echocardiographic measures of right ventricular systolic function.

CONCLUSIONS

The novel parameter E/DT outperforms the tissue Doppler index E/e' in detecting and monitoring lung remodeling induced by pressure overload. The results may provide a handy tool to point towards secondary lung disease in HFpEF and warrant further clinical investigations.

背景

射血分数保留的心力衰竭（HFpEF）中的舒张功能障碍可能导致肺充血和肺重塑。我们评估了主要舒张超声心动图参数和早期二尖瓣舒张速度减速率（E/DT）在预测 HFpEF 大鼠模型中肺重塑的有用性。

方法和结果

大鼠接受主动脉缩窄（AoB）以诱导压力超负荷（PO）。左心室肥厚在 AoB 后 2 周完全发展。在 4 周和 6 周时，尽管保留了分数缩短，肺重/体重比（LW/BW），肺充血和重塑的敏感标志物，显著增加，表明存在 HFpEF。LW/BW 的时间过程很好地反映了 E/DT、早期和晚期二尖瓣舒张速度比（E/A）和 E 的减速时间（DT），但不反映二尖瓣环早期舒张速度比（E/e'）。一致地，与 LW/BW 相关性最好的是 E/DT（r=0.76；p<0.0001），其次是 E/A（r=0.69；p<0.0001）、DT（r=-0.62；p<0.0001），最后是 E/e'（r=0.51；p<0.001）。此外，分析预测 LW/BW 增加的接受者操作特征曲线表明 E/DT（AUC=0.98）和 DT（AUC=0.95）的曲线下面积值优异，明显高于 E/e'（AUC=0.82）。在第二种方法中，我们还发现新参数 E/DT 与右心室重量指数和右心室收缩功能的超声心动图测量值密切相关。