Cardiovascular Center Aalst, OLV Clinic Aalst, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
Cardiovascular Center Aalst, OLV Clinic Aalst, Aalst, Belgium.
Int J Cardiol. 2021 Jan 15;323:161-167. doi: 10.1016/j.ijcard.2020.08.093. Epub 2020 Sep 1.
Diagnosis of heart failure with preserved ejection fraction (HFpEF) in patients with dyspnea and paroxysmal atrial fibrillation (AF) is challenging. Speckle tracking-derived left atrial strain (LAS) provides an accurate estimate of left ventricular (LV) filling pressures and left atrial (LA) phasic function. However, data on clinical utility of LAS in patients with dyspnea and AF are scarce.
To assess relationship between the LAS and the probability of HFpEF in patients with dyspnea and paroxysmal AF.
The study included 205 consecutive patients (62 ± 10 years, 58% males) with dyspnea (NYHA≥II), paroxysmal AF and preserved LV ejection fraction (≥50%), who underwent speckle tracking echocardiography during sinus rhythm. Probability of HFpEF was estimated using HFPEF and HFA-PEFF scores, which combine clinical characteristics, echocardiographic parameters and natriuretic peptides.
Patients with high probability of HFpEF were significantly older, had higher body mass index, NT-proBNP, E/e', pulmonary artery pressure and larger LA volume index than patients in low-to-intermediate probability groups (all p < 0.05). All components of LAS and LA strain rate showed proportional impairment with increasing probability of HFpEF (all p < 0.05). Out of the speckle tracking-derived parameters, reservoir LAS showed the largest area under the curve (AUC = 0.78, p < 0.001) and the strongest independent predictive value (OR: 1.22, 95% CI 1.08-1.38) to identify patients with high probability of HFpEF.
Reservoir LAS shows a high diagnostic performance to distinguish HFpEF from non-cardiac causes of dyspnea in symptomatic patients with paroxysmal AF.
对于呼吸困难和阵发性心房颤动（AF）的心力衰竭伴射血分数保留（HFpEF）患者的诊断具有挑战性。斑点追踪衍生的左心房应变（LAS）可准确估计左心室（LV）充盈压和左心房（LA）相功能。然而，关于呼吸困难和 AF 患者 LAS 的临床应用的数据很少。
评估呼吸困难和阵发性 AF 患者 LAS 与 HFpEF 概率之间的关系。
本研究纳入了 205 例连续呼吸困难（NYHA≥II）、阵发性 AF 和保留的 LV 射血分数（≥50%）患者，窦性心律下进行斑点追踪超声心动图检查。HFpEF 概率采用 HFPEF 和 HFA-PEFF 评分进行评估，该评分结合了临床特征、超声心动图参数和利钠肽。
HFpEF 高概率组患者年龄明显较大，体重指数、NT-proBNP、E/e'、肺动脉压和左心房容积指数均高于低至中概率组（均 P<0.05）。随着 HFpEF 概率的增加，LAS 和 LA 应变率的所有成分均呈比例受损（均 P<0.05）。在斑点追踪衍生参数中，储器 LAS 的曲线下面积（AUC=0.78，P<0.001）最大，对识别 HFpEF 高概率患者的预测价值最强（OR：1.22，95%CI 1.08-1.38）。
在有阵发性 AF 症状的呼吸困难患者中，储器 LAS 具有较高的鉴别诊断性能，可将 HFpEF 与非心脏原因引起的呼吸困难区分开来。
