HFPEF 评分可预测全身性结缔组织病患者的动脉粥样硬化存在。
H FPEF score predicts atherosclerosis presence in patients with systemic connective tissue disease.
机构信息
School of Medicine, University of Belgrade, Belgrade, Serbia.
Division of Cardiology, University Clinical Center of Serbia, Belgrade, Serbia.
出版信息
Clin Cardiol. 2021 Jul;44(7):946-954. doi: 10.1002/clc.23621. Epub 2021 Jun 2.
BACKGROUND
Cardiovascular diseases are common cause of morbidity and mortality in patients with systemic connective tissue diseases (SCTD) due to accelerated atherosclerosis which couldn't be explained by traditional risk factors (CVDRF).
HYPOTHESIS
We hypothesized that recently developed score predicting probability of heart failure with preserved ejection fraction (H FPEF), as well as a measure of right ventricular-pulmonary vasculature coupling [tricuspid annular plane systolic excursion (TAPSE)/pulmonary artery systolic pressure (PASP) ratio], are predictive of atherosclerosis in SCTD.
METHODS
203 patients (178 females) diagnosed with SCTD underwent standard and stress-echocardiography (SE) with TAPSE/PASP and left ventricular (LV) diastolic filling pressure (E/e') measurements, carotid ultrasound and computed tomographic coronary angiography. Patients who were SE positive for ischemia underwent coronary angiography (34/203). The H FPEF score was calculated according to age, body mass index, presence of atrial fibrillation, ≥2 antihypertensives, E/e' and PASP.
RESULTS
Mean LV ejection fraction was 66.3 ± 7.1%. Atherosclerosis was present in 150/203 patients according to: 1) intima-media thickness>0.9 mm; and 2) Agatstone score > 300 or Syntax score ≥ 1. On binary logistic regression analysis, including CVDRF prevalence, echocardiographic parameters and H FPEF score, only H FPEF score remained significant for the prediction of atherosclerosis presence (χ = 19.3, HR 2.6, CI 1.5-4.3, p < 0.001), and resting TAPSE/PASP for the prediction of a SE positive for ischemia (χ = 10.4, HR 0.01, CI = 0.01-0.22, p = 0.004). On ROC analysis, the optimal threshold value for identifying patients with atherosclerosis was a H FPEF score ≥2 (Sn 60.4%, Sp 69.4%, area 0.67, SE = 0.05, p < 0.001).
CONCLUSIONS
H FPEF score and resting TAPSE/PASP demonstrated clinical value for an atherosclerosis diagnosis in patients diagnosed with SCTD.
背景
心血管疾病是系统性结缔组织病（SCTD）患者发病率和死亡率的常见原因，这是由于动脉粥样硬化加速所致，而传统的风险因素（CVDRF）无法解释这一现象。
假说
我们假设，最近开发的预测射血分数保留的心力衰竭（HFPEF）概率的评分，以及右心室-肺血管耦联的测量指标[三尖瓣环平面收缩期位移（TAPSE）/肺动脉收缩压（PASP）比值]，可预测 SCTD 中的动脉粥样硬化。
方法
203 名（178 名女性）被诊断为 SCTD 的患者接受了标准和应激超声心动图（SE）检查，包括 TAPSE/PASP 和左心室（LV）舒张充盈压（E/e'）测量、颈动脉超声和计算机断层冠状动脉造影。SE 检查提示缺血的患者进行了冠状动脉造影（203 例中有 34 例）。HFPEF 评分根据年龄、体重指数、房颤、≥2 种降压药、E/e'和 PASP 计算得出。
结果
平均左心室射血分数为 66.3±7.1%。根据 1）内膜中层厚度>0.9mm；和 2）Agatstone 评分>300 或 Syntax 评分≥1，203 例患者中有 150 例存在动脉粥样硬化。在包括 CVDRF 患病率、超声心动图参数和 HFPEF 评分的二元逻辑回归分析中，仅 HFPEF 评分对动脉粥样硬化存在的预测具有显著意义（χ=19.3，HR 2.6，CI 1.5-4.3，p<0.001），静息 TAPSE/PASP 对 SE 检查提示缺血的预测具有显著意义（χ=10.4，HR 0.01，CI=0.01-0.22，p=0.004）。在 ROC 分析中，识别存在动脉粥样硬化的患者的最佳 HFPEF 评分阈值为≥2（Sn 60.4%，Sp 69.4%，面积 0.67，SE=0.05，p<0.001）。
结论
HFPEF 评分和静息 TAPSE/PASP 对 SCTD 患者的动脉粥样硬化诊断具有临床价值。
Zotero 插件