预测左心室充盈压的新参数：log B 型利钠肽与二尖瓣口舒张早期和晚期充盈速度比值的乘积。

Novel Parameter to Predict Left Ventricular Filling Pressure: Product of Log B-Type Natriuretic Peptide and Ratio of Mitral Inflow Early and Late Diastolic Filling Velocities.

机构信息

Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan.

出版信息

J Card Fail. 2018 Jan;24(1):29-32. doi: 10.1016/j.cardfail.2017.10.008. Epub 2017 Oct 12.

DOI:10.1016/j.cardfail.2017.10.008

PMID:29031870

Abstract

BACKGROUND

Several echocardiographic parameters are currently used to evaluate left ventricular (LV) filling pressure. However, these parameters are not always consistent in the clinical setting. We aimed to determine a novel parameter by multiplying log B-type natriuretic peptide (lnBNP) and the ratio of mitral inflow early and late diastolic filling velocities (E/A) for the prediction of pulmonary capillary wedge pressure (PCWP).

METHODS AND RESULTS

One hundred ninety-eight patients suspected of chronic heart failure were analyzed. The product of lnBNP and E/A (BNP × E/A) showed the highest correlation coefficient with mean PCWP (R = 0.7326) compared with E/A (R = 0.7010) and E/e' (R = 0.3922). Multivariate logistic regression analysis revealed that BNP × E/A was associated with elevated PCWP (odds ratio 1.640, 95% confidence interval 1.312-2.197; P <.01). In the receiver operating characteristic curve analysis for detecting elevated PCWP, BNP × E/A showed the largest area under the curve (AUC) compared with E/A and E/e' (0.880 vs 0.827 and 0.788, respectively; P <.05). BNP × E/A still showed large AUC (0.842) for detection of elevated PCWP in patients with normal LV ejection fraction.

CONCLUSION

BNP × E/A is a useful parameter for detecting elevated PCWP regardless of the LV ejection fraction.

摘要

背景

目前有几种超声心动图参数可用于评估左心室（LV）充盈压。然而，这些参数在临床环境中并不总是一致的。我们旨在通过将 B 型利钠肽（lnBNP）的对数和二尖瓣血流早期和晚期舒张充盈速度的比值（E/A）相乘，确定一种预测肺毛细血管楔压（PCWP）的新参数。

方法和结果

对 198 例疑似慢性心力衰竭的患者进行了分析。lnBNP 与 E/A 的乘积（BNP×E/A）与平均 PCWP 的相关性最高（R=0.7326），而 E/A（R=0.7010）和 E/e'（R=0.3922）则次之。多变量逻辑回归分析显示，BNP×E/A 与 PCWP 升高相关（比值比 1.640，95%置信区间 1.312-2.197；P<.01）。在用于检测 PCWP 升高的受试者工作特征曲线分析中，与 E/A 和 E/e'相比，BNP×E/A 显示出最大的曲线下面积（AUC）（0.880 比 0.827 和 0.788，分别；P<.05）。在 LV 射血分数正常的患者中，BNP×E/A 检测 PCWP 升高时仍具有较大的 AUC（0.842）。