Fujii Toshiharu, Yoshioka Koichiro, Nakano Masataka, Nakazawa Gaku, Amino Mari, Masuda Naoki, Shinozaki Norihiko, Kanda Shigetaka, Ogata Nobuhiko, Deguchi Yoshiaki, Yoshimachi Fuminobu, Ikari Yuji
Department of Cardiology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193 Japan.
J Echocardiogr. 2013;11(4):138-46. doi: 10.1007/s12574-013-0193-x. Epub 2013 Sep 26.
The impact of regional wall motion abnormality (RWMA) on the accuracy of heart failure with preserved ejection fraction (HFpEF) diagnosis using the E/e' ratio, which is a non-invasive parameter of left ventricular diastolic performance, is unknown. The purpose of this study was to elucidate the impact of RWMA of the lateral wall (RWMAlat) on the correlation between E/e' and invasive parameters of left ventricular diastolic performance.
Three hundred and eight consecutive patients undergoing tissue Doppler imaging and catheterization pressure examination were retrospectively analyzed. E/e' was calculated as the ratio of early diastolic transmitral flow velocity to mitral annular velocity at the lateral wall. Invasive parameters including left ventricular end-diastolic pressure (LVEDP) and isovolumetric relaxation time constant (τ) were assessed based on the left ventricular pressure study. Correlation coefficients between E/e' and these invasive parameters were analyzed and compared between cases with RWMAlat and without RWMA.
LVEDP and τ correlated well with E/e' for all 308 patients (r = 0.51 and r = 0.65, respectively). Sixty-two patients had RWMA; the remaining 246 did not have RWMAlat. We confirmed that the presence of RWMAlat weakens both the correlations between E/e' and LVEDP (r = 0.574 vs. r = 0.381), and E/e' and τ (r = 0.729 vs. r = 0.461).
Although E/e' correlates well with parameters of left ventricular diastolic performance assessed by invasive methods, the presence of RWMAlat worsens this correlation. In cases with RWMAlat, careful assessment is required for HFpEF diagnosis because the diagnostic value of the E/e' ratio could be decreased compared to patients without RWMAlat.
区域室壁运动异常（RWMA）对使用E/e'比值诊断射血分数保留的心力衰竭（HFpEF）准确性的影响尚不清楚，E/e'比值是左心室舒张功能的一项非侵入性参数。本研究的目的是阐明侧壁RWMA（RWMAlat）对E/e'与左心室舒张功能侵入性参数之间相关性的影响。
回顾性分析308例连续接受组织多普勒成像和导管压力检查的患者。E/e'计算为舒张早期二尖瓣血流速度与侧壁二尖瓣环速度之比。基于左心室压力研究评估包括左心室舒张末期压力（LVEDP）和等容舒张时间常数（τ）在内的侵入性参数。分析E/e'与这些侵入性参数之间的相关系数，并在有RWMAlat和无RWMA的病例之间进行比较。
对于所有308例患者，LVEDP和τ与E/e'均具有良好的相关性（r分别为0.51和0.65）。62例患者存在RWMA；其余246例没有RWMAlat。我们证实，RWMAlat的存在削弱了E/e'与LVEDP之间的相关性（r = 0.574对r = 0.381）以及E/e'与τ之间的相关性（r = 0.729对r = 0.461）。
尽管E/e'与通过侵入性方法评估的左心室舒张功能参数具有良好的相关性，但RWMAlat的存在会使这种相关性变差。在存在RWMAlat的病例中，由于与没有RWMAlat的患者相比，E/e'比值的诊断价值可能会降低，因此对于HFpEF诊断需要进行仔细评估。
