Department of Cardiology, VM Medical Park Pendik Hospital, Eski Karakol Str. No: 9 Pendik, Istanbul, Turkey.
Department of Cardiology, Dr. Siyami Ersek Cardiovascular and Thoracic Surgery Research and Training Hospital, Istanbul, Turkey.
Int J Cardiovasc Imaging. 2020 Sep;36(9):1699-1709. doi: 10.1007/s10554-020-01886-6. Epub 2020 May 21.
Measurement of pulmonary venous flow (PVF) parameters can be used to estimate left ventricular end-diastolic pressure (LVEDP) on transthoracic echocardiography. Despite that, 2016 American Society of Echocardiography (ASE)/European Association of Cardiovascular Imaging (EACVI) algorithm gave a secondary role to PVF to assess left ventricular filling pressure. We aimed to test correlations between several PVF parameters, including novel measurements, with LVEDP and to analyze whether PVF parameters have an incremental usefulness over ASE/EACVI algorithm to estimate LVEDP. Seventy-two patients that underwent left and right cardiac catheterization for assessment of heart failure or pulmonary hypertension were enrolled. All patients had a detailed echocardiographic study immediately before catheterization. Patients were categorized into those with an LVEDP < 15 mmHg vs. LVEDP ≥ 15 mmHg to analyze data. Patients with an elevated LVEDP had significantly lower peak S/D velocity ratio, S wave deceleration time, D wave acceleration time and D wave deceleration time (DWDT), as well as higher D wave acceleration rate (DWAR), but only peak S/D velocity ratio (β = - 0.28, p = 0.01), DWDT (β = - 0.33, p = 0.001) and DWAR (β = 0.23, p = 0.03) were independent predictors for an elevated LVEDP. ASE/EACVI algorithm had a sensitivity of 71% and specificity of 74% to predict an elevated LVEDP. When PVF parameters were adjusted for ASE/EACVI algorithm; DWDT and DWAR remained as independent predictors. Sensitivity and specificity of ASE/EACVI algorithm increased to 79% and 96%, respectively, if either DWDT or DWAR was also suggestive of an elevated LVEDP. DWDT and DWAR have incremental usefulness over existing algorithm to determine LVEDP.
经胸超声心动图测量肺静脉血流（PVF）参数可用于估计左心室舒张末期压（LVEDP）。尽管如此，2016 年美国超声心动图学会（ASE）/欧洲心血管影像协会（EACVI）算法将 PVF 评估左心室充盈压的次要作用。我们旨在测试几种 PVF 参数与 LVEDP 的相关性，包括新的测量方法，并分析 PVF 参数是否比 ASE/EACVI 算法具有更高的 LVEDP 估计增量有用性。72 例患者因心力衰竭或肺动脉高压而行左、右心导管检查，均在导管检查前进行详细的超声心动图检查。将患者分为 LVEDP<15mmHg 和 LVEDP≥15mmHg 两组进行数据分析。LVEDP 升高的患者峰值 S/D 速度比、S 波减速时间、D 波加速时间和 D 波减速时间（DWDT）明显降低，D 波加速率（DWAR）明显升高，但只有峰值 S/D 速度比（β=−0.28，p=0.01）、DWDT（β=−0.33，p=0.001）和 DWAR（β=0.23，p=0.03）是 LVEDP 升高的独立预测因素。ASE/EACVI 算法预测 LVEDP 升高的敏感性为 71%，特异性为 74%。当将 PVF 参数调整为 ASE/EACVI 算法时，DWDT 和 DWAR 仍然是独立的预测因素。如果 DWDT 或 DWAR 也提示 LVEDP 升高，ASE/EACVI 算法的敏感性和特异性分别增加到 79%和 96%。DWDT 和 DWAR 对确定 LVEDP 具有增量有用性。
