Heart Institute, Medical School, University of Pécs, Ifjúság u. 13., Pécs, 7624, Hungary.
Department of Laboratory Medicine, Medical School, University of Pécs, Ifjúság u. 13., Pécs, 7624, Hungary.
Int J Cardiovasc Imaging. 2019 Oct;35(10):1795-1802. doi: 10.1007/s10554-019-01621-w. Epub 2019 May 15.
Heart failure with preserved ejection fraction (HFpEF) is common in systemic sclerosis (SSc) and implies a worse prognosis therefore non-invasive assessment of left ventricular (LV) filling pressure is pivotal. Besides E/e' the use of maximal left atrial volume (LA Vmax index) is recommended. LA reservoir strain was also reported to be useful. The utility of LA stiffness, however, was never investigated in SSc. Thus we aimed to compare the diagnostic power of LA Vmax index, reservoir strain and stiffness in predicting elevated LV filling pressure in SSc patients. 72 SSc patients (age: 57 ± 11 years) were investigated. LA stiffness was calculated as ratio of E/e' to LA reservoir strain. Elevated LV filling pressure was defined as NT-proBNP > 220 pg/ml. Receiver-operating characteristic (ROC) curves were used to estimate the diagnostic performance of the investigated parameters. Average NT-proBNP level was 181 ± 154 pg/ml. NT-proBNP > 220 pg/ml was found in 21 SSc patients. LA stiffness showed the highest diagnostic performance in predicting NT-pro-BNP > 220 pg/ml, with a cut off value of 0.314 (Area under the curve: 0.719, specificity: 89.4%, sensitivity: 42.1%). AUC values for LA reservoir strain and Vmax index were 0.595 and 0.521, respectively. LA stiffness was superior to Vmax index and reservoir strain in predicting elevated NT-proBNP levels in SSc patients. Although invasive validation studies on larger samples are required, our data suggest, that the use of LA stiffness may significantly contribute to diagnostic precision in populations with a high suspicion of HFpEF.
射血分数保留的心力衰竭（HFpEF）在系统性硬化症（SSc）中很常见，因此预示着预后更差，因此，非侵入性评估左心室（LV）充盈压至关重要。除了 E/e' 之外，还推荐使用最大左心房容积（LA Vmax 指数）。也有报道称左心房储备应变有用。然而，LA 僵硬度在 SSc 中从未被研究过。因此，我们旨在比较 LA Vmax 指数、储备应变和僵硬度在预测 SSc 患者 LV 充盈压升高方面的诊断能力。
共纳入 72 名 SSc 患者（年龄：57±11 岁）。LA 僵硬度的计算方法为 E/e'与 LA 储备应变的比值。LV 充盈压升高定义为 NT-proBNP＞220pg/ml。使用受试者工作特征（ROC）曲线评估所研究参数的诊断性能。
平均 NT-proBNP 水平为 181±154pg/ml。21 名 SSc 患者的 NT-proBNP＞220pg/ml。LA 僵硬度在预测 NT-pro-BNP＞220pg/ml 方面具有最高的诊断性能，截断值为 0.314（曲线下面积：0.719，特异性：89.4%，敏感性：42.1%）。LA 储备应变和 Vmax 指数的 AUC 值分别为 0.595 和 0.521。LA 僵硬度在预测 SSc 患者 NT-proBNP 水平升高方面优于 Vmax 指数和储备应变。尽管需要在更大的样本上进行有创验证研究，但我们的数据表明，在 HFpEF 高度怀疑的人群中，LA 僵硬度的使用可能显著有助于提高诊断精度。
