Department of Internal Medicine and Cardiology, Charité University Medicine Berlin - Campus Virchow Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany.
German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Germany.
Eur Heart J Cardiovasc Imaging. 2020 Mar 1;21(3):260-269. doi: 10.1093/ehjci/jez272.
The aim of this study was to examine the potential usefulness and clinical relevance of a novel left atrial (LA) filling index using 2D speckle-tracking transthoracic echocardiography to estimate left ventricular (LV) filling pressures in patients with preserved LV ejection fraction (LVEF).
The LA filling index was calculated as the ratio of the mitral early-diastolic inflow peak velocity (E) over LA reservoir strain (i.e. E/LA strain ratio). This index showed a good diagnostic performance to determine elevated LV filling pressures in a test-cohort (n = 31) using invasive measurements of LV end-diastolic pressure (area under the curve 0.82, cut-off > 3.27 = sensitivity 83.3%, specificity 78.9%), which was confirmed in a validation-cohort (patients with cardiovascular risk factors; n = 486) using the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging criteria (cut-off > 3.27 = sensitivity 88.1%, specificity 77.6%) and in a specificity-validation cohort (patients free of cardiovascular risk factors, n = 120; cut-off > 3.27 = specificity 98.3%). Regarding the clinical relevance of the LA filling index, an elevated E/LA strain ratio (>3.27) was significantly associated with the risk of heart failure hospitalization at 2 years (odds ratio 4.3, 95% confidence interval 1.8-10.5), even adjusting this analysis by age, sex, renal failure, LV hypertrophy, or abnormal LV global longitudinal systolic strain.
The findings from this study suggest that a novel LA filling index using 2D speckle-tracking echocardiography could be of potential usefulness and clinical relevance in estimating LV filling pressures in patients with preserved LVEF.
本研究旨在探讨一种新型左心房（LA）充盈指数的潜在有用性和临床相关性，该指数使用二维斑点追踪经胸超声心动图来评估左心室射血分数（LVEF）保留的患者的左心室（LV）充盈压。
LA 充盈指数通过二尖瓣早期舒张流入峰速度（E）与 LA 储器应变之比（即 E/LA 应变比）计算得出。该指数在使用 LV 舒张末期压力的侵入性测量来确定试验队列（n=31）中的升高的 LV 充盈压时表现出良好的诊断性能（曲线下面积 0.82，截断值>3.27=敏感性 83.3%，特异性 78.9%），这在验证队列（心血管危险因素患者；n=486）中使用 2016 年美国超声心动图学会/欧洲心血管成像协会标准得到了证实（截断值>3.27=敏感性 88.1%，特异性 77.6%），在特异性验证队列（无心血管危险因素的患者，n=120；截断值>3.27=特异性 98.3%）中也得到了证实。关于 LA 充盈指数的临床相关性，升高的 E/LA 应变比（>3.27）与 2 年内心力衰竭住院的风险显著相关（优势比 4.3，95%置信区间 1.8-10.5），即使在分析中调整了年龄、性别、肾衰竭、LV 肥厚或异常的 LV 整体纵向收缩应变。
这项研究的结果表明，使用二维斑点追踪超声心动图的新型 LA 充盈指数可能在评估保留 LVEF 的患者的 LV 充盈压方面具有潜在的有用性和临床相关性。
