Department of Cardiovascular Medicine, 200 First St SW, Rochester, MN, 55905, USA.
Department of Medicine, Faculty of Medicine, Division of Cardiology at the University of British Columbia, Vancouver, BC, Canada.
J Echocardiogr. 2021 Sep;19(3):158-165. doi: 10.1007/s12574-020-00509-2. Epub 2021 Jan 12.
The utility of Doppler velocities across the patent foramen ovale (PFO) to estimate left ventricular (LV) filling pressure is not well known.
The best cut-off value of peak interatrial septal velocity across a transeptal puncture site measured by transesophageal echocardiography for estimating high mean left atrial (LA) pressure (≥ 15 mmHg) was determined in 17 patients. This cut-off value was subsequently applied to 67 patients with a PFO undergoing transthoracic echocardiography (TTE) for assessing the value of PFO velocity in determining LV filling pressure.
The peak systolic interatrial septal velocities significantly correlated with directly measured mean LA pressures during transcatheter mitral valve procedure (r = 0.77, P < 0.001). The best cut-off value was 1.7 m/s for predicting high LA pressure (AUC 0.91; sensitivity 90%, specificity 86%). When this cut-off was applied to patients undergoing TTE, peak PFO velocity ≥ 1.7 m/s correlated with reduced e', higher E/e', and higher tricuspid regurgitation velocity (P < 0.01). LV filling pressure according to the 2016 diastolic guideline was compared with peak PFO velocity in 51 patients. Among patients with high filling pressure according to the guidelines (n = 20), peak PFO velocity ≥ 1.7 m/s was present in 60% of patients. In patients with normal filling pressure per the guidelines (n = 31), PFO velocity < 1.7 m/s was present 84%. Sensitivity and specificity were 75% and 92%, respectively, in patients with sinus rhythm, but were only 50% and 57%, respectively, among patients with atrial fibrillation.
Doppler-derived peak PFO velocities could be valuable in the assessment of increased LV filling pressure using 1.7 m/s as the cut-off value.
经食管超声心动图测量的卵圆孔未闭（PFO）跨房间隔峰值速度在评估左心室（LV）充盈压中的应用尚不清楚。
通过经食管超声心动图测量经房间隔穿刺部位的房间隔峰值速度，确定最佳截断值，用于评估 17 例高平均左心房（LA）压（≥15mmHg）的患者。随后，该截断值应用于 67 例接受经胸超声心动图（TTE）检查以评估 PFO 速度在确定 LV 充盈压中的价值的 PFO 患者。
在经导管二尖瓣手术期间，收缩期房间隔峰值速度与直接测量的平均 LA 压力显著相关（r=0.77，P<0.001）。最佳截断值为 1.7m/s 预测高 LA 压（AUC 0.91；敏感性 90%，特异性 86%）。当该截断值应用于接受 TTE 的患者时，PFO 峰值速度≥1.7m/s 与降低的 e'、更高的 E/e'和更高的三尖瓣反流速度相关（P<0.01）。在 51 例患者中，根据 2016 年舒张期指南比较了 LV 充盈压和 PFO 峰值速度。根据指南，在高充盈压的患者中（n=20），60%的患者 PFO 峰值速度≥1.7m/s。根据指南，在正常充盈压的患者中（n=31），PFO 速度<1.7m/s 的患者占 84%。窦性心律患者的敏感性和特异性分别为 75%和 92%，而房颤患者分别为 50%和 57%。
以 1.7m/s 为截断值，多普勒衍生的 PFO 峰值速度可用于评估 LV 充盈压增加。
