GIGA Cardiovascular Science, Heart Valve Clinic, Imaging Cardiology, University of Liège Hospital, B-4000 Liege, Belgium.
Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy.
Eur Heart J Cardiovasc Imaging. 2017 Sep 1;18(9):961-968. doi: 10.1093/ehjci/jex067.
AIMS: The present Euro-Filling report aimed at comparing the diagnostic accuracy of the 2009 and 2016 echocardiographic grading algorithms for predicting invasively measured left ventricular filling pressure (LVFP). METHOD AND RESULTS: A total of 159 patients who underwent simultaneous evaluation of echo estimates of LVFP and invasive measurements of LV end-diastolic pressure (LVEDP) were enrolled at nine EACVI centres. Thirty-nine (25%) patients had a reduced LV ejection fraction (<50%), 77 (64%) were in NYHA ≥ II, and 85 (53%) had coronary artery disease. Sixty-four (40%) patients had elevated LVEDP (≥15 mmHg). Taken individually, all echocardiographic Doppler estimates of LVFP (E/A, E/e', left atrial volume, tricuspid regurgitation jet velocity) were marginally correlated with LVEDP. By using the 2016 recommendations, 65% of patients with normal non-invasive estimate of LVFP had normal LVEDP, while 79% of those with elevated non-invasive LVFP had elevated invasive LVEDP. By using 2009 recommendations, 68% of the patients with normal non-invasive LVFP had normal LVEDP, while 55% of those with elevated non-invasive LVFP had elevated LVEDP. The 2016 recommendations (sensitivity 75%, specificity 74%, positive predictive value 39%, negative predictive value 93%, AUC 0.78) identified slightly better patients with elevated invasive LVEDP (≥ 15 mmHg) as compared with the 2009 recommendations (sensitivity 43%, specificity 75%, positive predictive value 49%, negative predictive value 71%, AUC 0.68). CONCLUSION: The present Euro-Filling study demonstrates that the new 2016 recommendations for assessing LVFP non-invasively are fairly reliable and clinically useful, as well as superior to the 2009 recommendations in estimating invasive LVEDP.
目的:本 Euro-Filling 报告旨在比较 2009 年和 2016 年超声心动图分级算法在预测有创测量左心室充盈压(LVFP)方面的诊断准确性。
方法和结果:本研究纳入了 9 个 EACVI 中心的 159 名同时接受超声心动图估计 LVFP 和左心室舒张末期压(LVEDP)有创测量的患者。39 名(25%)患者左心室射血分数降低(<50%),77 名(64%)为纽约心脏协会(NYHA)≥II 级,85 名(53%)患有冠状动脉疾病。64 名(40%)患者 LVEDP 升高(≥15mmHg)。单独来看,所有超声心动图多普勒估计的 LVFP(E/A、E/e'、左心房容积、三尖瓣反流射流速度)与 LVEDP 均有轻微相关性。根据 2016 年的建议,65%的非侵入性 LVFP 正常的患者 LVEDP 正常,而 79%的非侵入性 LVFP 升高的患者 LVEDP 升高。根据 2009 年的建议,68%的非侵入性 LVFP 正常的患者 LVEDP 正常,而 55%的非侵入性 LVFP 升高的患者 LVEDP 升高。2016 年的建议(敏感性 75%,特异性 74%,阳性预测值 39%,阴性预测值 93%,AUC 0.78)比 2009 年的建议(敏感性 43%,特异性 75%,阳性预测值 49%,阴性预测值 71%,AUC 0.68)能更好地识别出 LVEDP(≥15mmHg)升高的患者。
结论:本 Euro-Filling 研究表明,新的 2016 年非侵入性评估 LVFP 的建议相当可靠且具有临床实用性,在估计有创 LVEDP 方面优于 2009 年的建议。
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