Hametner Bernhard, Parragh Stephanie, Weber Thomas, Wassertheurer Siegfried
Biomedical Systems, Center for Health & Bioresources, AIT Austrian Institute of Technology GmbH, Vienna, Austria.
Institute for Analysis and Scientific Computing, Vienna University of Technology, Vienna, Austria.
PLoS One. 2017 Jun 19;12(6):e0179938. doi: 10.1371/journal.pone.0179938. eCollection 2017.
Systolic left ventricular function strongly influences the blood pressure waveform. Therefore, pressure-derived parameters might potentially be used as non-invasive, diagnostic markers of left ventricular impairment. The aim of this study was to investigate the performance of pressure-based parameters in combination with electrocardiography (ECG) for the detection of left ventricular systolic dysfunction defined as severely reduced ejection fraction (EF).
Two populations, each comprising patients with reduced EF and pressure-matched controls, were included for the main analysis (51/102 patients) and model testing (44/88 patients). Central pressure was derived from radial readings and used to compute blood flow. Subsequently, pulse wave analysis and wave intensity analysis were performed and the ratio of the two peaks of forward intensity (SDR) was calculated as a novel index of ventricular function. SDR was significantly decreased in the reduced EF group (2.5 vs. 4.4, P<0.001), as was central pulse pressure, augmentation index and ejection duration (ED), while the QRS-duration was prolonged. SDR and ED were independent predictors of ventricular impairment and when combined with QRS in a simple decision tree, a reduced EF could be detected with a sensitivity of 92% and a specificity of 80%. The independent power of ED, SDR and QRS to predict reduced EF was furthermore confirmed in the test population.
The detection or indication of reduced ejection fraction from pressure-derived parameters seems feasible. These parameters could help to improve the quality of cardiovascular risk stratification or might be used in screening strategies in the general population.
左心室收缩功能对血压波形有强烈影响。因此，基于压力的参数有可能被用作左心室功能损害的非侵入性诊断标志物。本研究的目的是探讨基于压力的参数与心电图（ECG）相结合在检测定义为射血分数（EF）严重降低的左心室收缩功能障碍方面的性能。
纳入了两个人群，每个群体都包括EF降低的患者和压力匹配的对照组，用于主要分析（51/102例患者）和模型测试（44/88例患者）。中心压力由桡动脉读数得出并用于计算血流。随后，进行脉搏波分析和波强度分析，并计算正向强度两个峰值的比值（SDR）作为心室功能的新指标。EF降低组的SDR显著降低（2.5对4.4，P<0.001），中心脉压、增强指数和射血持续时间（ED）也降低，而QRS时限延长。SDR和ED是心室功能损害的独立预测因素，当在简单决策树中与QRS相结合时，检测到EF降低的敏感性为92%，特异性为80%。ED、SDR和QRS预测EF降低的独立能力在测试人群中也得到了证实。
从基于压力的参数检测或提示射血分数降低似乎是可行的。这些参数有助于提高心血管风险分层的质量，或可用于一般人群的筛查策略。
