First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
Cardiovasc Ultrasound. 2021 Apr 24;19(1):17. doi: 10.1186/s12947-021-00248-z.
We sought to explore the relationship between an index of left ventricular diastolic function parameters combined with left atrial strain and the diastolic function of patients with preserved ejection fraction.
We prospectively enrolled 388 patients with left ventricular ejection fraction (LVEF) ≥ 50%, 49 of whom underwent left heart catherization. Transthoracic echocardiography was performed within 12 h before or after the procedure. Left atrial (LA) strain was obtained by speckle tracking echocardiography. These patients served as the test group. The remaining patients (n = 339) were used to validate the diagnostic performance of the mitral early-diastolic inflow peak velocity (E)-to-left atrial reservoir strain ratio (E/LASr) in left ventricular diastolic dysfunction.
Invasive measurements of LV end-diastolic pressure (LVEDP) demonstrated that the E/LASr ratio was increased in patients with elevated LVEDP [ 2.0 (1.8-2.2) vs 3.0 (2.6-4.0), p < 0.001] in the test group (n = 49). After adjusting for age, mitral A, E/e' ratio and β-blocker use, the E/LASr ratio was an independent predictor of elevated LVEDP and showed good diagnostic performance in determining elevated LVEDP [area under the curve (AUC) 0.903, cutoff value 2.7, sensitivity 74.2%, specificity 94.4%]. In the validation group (n = 339), the E/LASr ratio also performed well in diagnosing elevated left atrial pressure (LAP) (AUC 0.904, cutoff value 3.2, sensitivity 76.5%, specificity 89.0%), while with a cut-off value of 2.7, the E/LASr ratio showed high accuracy in discriminating elevated LAP. In addition, E/LASr was a good index of excellent diagnostic utility (AUC: 0.899 to 0.996) in the categorization of diastolic dysfunction grades. Regarding the clinical relevance of this index, the E/LASr ratio could accurately diagnose HF with preserved ejection fraction (HFpEF) (0.781), especially in patients with "indeterminate" status (AUC: 0.829). Furthermore, an elevated E/LASr ratio was significantly associated with the risk of rehospitalization due to major adverse cardiac events (MACEs) within one year (odds ratio: 1.183, 95% confidence interval: 1.067, 1.312).
In patients with EF preservation, the E/LASr ratio is a novel index for assessing elevated left ventricular filling pressure with high accuracy.
我们旨在探讨联合左心房应变的左心室舒张功能参数指数与射血分数保留的心力衰竭患者舒张功能之间的关系。
我们前瞻性纳入了 388 例左心室射血分数（LVEF）≥50%的患者，其中 49 例行左心导管术。在操作前或后 12 小时内行经胸超声心动图检查。应用斑点追踪超声心动图获取左心房应变。这些患者为实验组。其余 339 例患者（n=339）用于验证二尖瓣早期舒张流入峰速度（E）与左心房储备应变比（E/LASr）在左心室舒张功能障碍中的诊断性能。
实验组（n=49）中，LVEDP 升高的患者的 LVEDP 测量值显示 E/LASr 比值升高[2.0（1.8-2.2）vs 3.0（2.6-4.0），p<0.001]。在校正年龄、二尖瓣 A、E/e' 比值和β受体阻滞剂使用后，E/LASr 比值是 LVEDP 升高的独立预测因子，在确定 LVEDP 升高方面具有良好的诊断性能[曲线下面积（AUC）0.903，截断值 2.7，灵敏度 74.2%，特异性 94.4%]。在验证组（n=339）中，E/LASr 比值在诊断左心房压（LAP）升高方面也表现良好（AUC 0.904，截断值 3.2，灵敏度 76.5%，特异性 89.0%），而截断值为 2.7 时，E/LASr 比值在鉴别 LAP 升高方面具有较高的准确性。此外，E/LASr 是区分舒张功能分级的优秀诊断工具的良好指标（AUC：0.899 至 0.996）。关于该指标的临床相关性，E/LASr 比值可以准确诊断射血分数保留的心衰（HFpEF）（0.781），特别是在“不确定”状态下（AUC：0.829）。此外，E/LASr 比值升高与一年内因主要不良心脏事件（MACEs）再住院的风险显著相关（比值比：1.183，95%置信区间：1.067，1.312）。
在射血分数保留的患者中，E/LASr 比值是一种评估左心室充盈压升高的新指标，具有较高的准确性。
