CHU Rennes, Service de Cardiologie et Maladies Vasculaires et CIC-IT 1414, Rennes 35000, France; Université de Rennes 1, LTSI, Rennes 35000, France; INSERM, U1099, Rennes 35000, France.
INSERM, Centre d'Investigations Cliniques 1433, Université de Lorraine, CHU de Nancy, Institut Lorrain du Cœur et des Vaisseaux, Nancy, France and INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN network, Nancy, France.
Int J Cardiol. 2019 Apr 15;281:62-68. doi: 10.1016/j.ijcard.2019.01.055. Epub 2019 Jan 17.
The current algorithm in transthoracic echocardiography (TTE) proposed in the 2016 ASE/EACVI recommendation for the estimation of left ventricular filling pressure (LVFP) is quite complex and time-consuming. B-lines, in lung ultrasonography (LUS), could constitute an interesting tool for LVFP evaluation in clinical practice, although data regarding their association with invasive haemodynamics are lacking. The purpose of this study was to explore the diagnostic accuracy of B-lines in identifying elevated left ventricular end-diastolic pressure (LVEDP).
81 adults with significant dyspnoea (NYHA ≥ 2) were prospectively analyzed by LUS in four areas in each hemithorax and a complete TTE within four hours prior to coronary angiography. Twenty-eight patients had elevated LVEDP. Clinical variables yielded a C-index of 79% to identify elevated LVEDP. The number of total B-lines was higher in the elevated LVEDP group (1.0vs17.0, p < 0.0001) and significantly increased the diagnostic accuracy (C-index increase = 10.5%, p = 0.002) and net reclassification index (NRI = 145.4, 113.0-177.9, p < 0.0001) on top of clinical variables.
This study demonstrates the substantial diagnostic capacity of B-lines to identify elevated LVEDP, which appears superior to that of classical echocardiographic strategies. This tool should be considered in a multi-parametric approach in patients with heart failure.
2016 年美国超声心动图学会（ASE）/欧洲心血管影像协会（EACVI）推荐的用于估计左心室充盈压（LVFP）的经胸超声心动图（TTE）中的当前算法非常复杂且耗时。在肺部超声（LUS）中，B 线可能是评估 LVFP 的一种很有前途的临床工具，但缺乏其与有创血流动力学相关的数据。本研究旨在探讨 B 线诊断左心室舒张末期压（LVEDP）升高的准确性。
81 名有明显呼吸困难（NYHA≥2）的成年人在进行冠状动脉造影前 4 小时内前瞻性地进行了 LUS 检查，每个半胸的 4 个区域进行 LUS 检查，并在同一时间内完成了完整的 TTE。28 名患者的 LVEDP 升高。临床变量对识别 LVEDP 升高的 C 指数为 79%。LVEDP 升高组的总 B 线数量较高（1.0 比 17.0，p<0.0001），并显著提高了诊断准确性（C 指数增加 10.5%，p=0.002）和净重新分类指数（NRI=145.4，113.0-177.9，p<0.0001）。
本研究表明，B 线在识别 LVEDP 升高方面具有很大的诊断能力，似乎优于经典超声心动图策略。在心力衰竭患者中，应考虑将此工具纳入多参数方法。
