Yamamoto Junki, Wakami Kazuaki, Muto Keisuke, Kikuchi Shohei, Goto Toshihiko, Fukuta Hidekatsu, Seo Yoshihiro, Ohte Nobuyuki
Department of Cardiology, Nagoya City University Graduate School of Medical Sciences Nagoya Japan.
Circ Rep. 2019 Oct 31;1(11):525-530. doi: 10.1253/circrep.CR-19-0094.
Non-invasive evaluation of left ventricular (LV) diastolic dysfunction (DD) and elevated LV filling pressure are crucial for diagnosing heart failure. The 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging (ASE/EACVI) recommendations for evaluating elevated LV filling pressure (algorithm B) have acceptable diagnostic accuracy, including in patients with reduced LV ejection fraction (EF). No prior study, however, has assessed the diagnostic accuracy of algorithm A of the ASE/EACVI recommendations for evaluating LVDD in patients with normal LVEF. We evaluated the clinical relevance of algorithm A in 94 patients who underwent invasive LV pressure measurement. Algorithm A identified invasively defined LVDD (time constant τ≥48 ms and/or LV end-diastolic pressure ≥16 mmHg) with low sensitivity (22.4%) but high specificity (90.7%). Algorithm A also identified elevated LV filling pressure with low sensitivity (41.7%) but high specificity (87.5%), and with a high negative predictive value (90.9%). Algorithm A may not be useful for screening LVDD in patients with normal LVEF. Negative findings using algorithm A, however, may identify a patient with normal LVDD with high specificity, and most of such patients will have LV pre-A pressure in the normal range.
对左心室(LV)舒张功能障碍(DD)和左心室充盈压升高进行无创评估对于心力衰竭的诊断至关重要。2016年美国超声心动图学会/欧洲心血管影像协会(ASE/EACVI)关于评估左心室充盈压升高的建议(算法B)具有可接受的诊断准确性,包括在左心室射血分数(EF)降低的患者中。然而,此前尚无研究评估ASE/EACVI建议中算法A在评估左心室射血分数正常患者的左心室舒张功能障碍时的诊断准确性。我们对94例接受有创左心室压力测量的患者评估了算法A的临床相关性。算法A识别出有创定义的左心室舒张功能障碍(时间常数τ≥48毫秒和/或左心室舒张末期压力≥16毫米汞柱),敏感性较低(22.4%)但特异性较高(90.7%)。算法A还识别出左心室充盈压升高,敏感性较低(41.7%)但特异性较高(87.5%),且具有较高的阴性预测值(90.9%)。算法A可能对筛查左心室射血分数正常患者的左心室舒张功能障碍无用。然而,使用算法A得出的阴性结果可能以高特异性识别左心室舒张功能正常的患者,并且大多数此类患者的左心室前负荷压力在正常范围内。
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