等容收缩期联合房室纵向应变率可预测收缩功能障碍患者的肺毛细血管楔压。
Combined atrioventricular longitudinal strain rate during isovolumic contraction predicts pulmonary capillary wedge pressure in patients with systolic dysfunction.
作者信息
Omar Alaa Mabrouk Salem, Ronderos Botero Diana Maria, Arreaza Caraballo Javier, Kim Ga Hee, Khachatoorian Yeraz, Sharma Pranav, Bella Jonathan N, Contreras Johanna, Rifaie Osama, Abdel-Rahman Mohamed A
机构信息
Department of Cardiovascular Medicine, Mount Sinai Morningside New York, NY, USA.
Department of Medicine, BronxCare Hospital Center Bronx, NY, USA.
出版信息
Am J Cardiovasc Dis. 2021 Aug 15;11(4):530-538. eCollection 2021.
BACKGROUND
Reportedly, mitral annular velocities derived by tissue Doppler imaging (TDI)-during isovolumic contraction (IVV) can predict pulmonary capillary wedge pressure (PCWP) in heart failure patients with depressed ejection fraction (EF). We investigated the use of color TDI-derived left atrial (LA) and left ventricular (LV) longitudinal strain rate (SR) during isovolumic contraction (IC) to predict the invasively measured PCWP.
METHODS AND RESULTS
Forty patients referred with symptoms of heart failure were prospectively studied [age: 56±8 years, 12 (30%) females, and mean LVEF: 51±14%]. PCWP was measured invasively immediately after echocardiography. Mitral annular IVV was measured for all patients and SR during the IC and ejection were measured for the LV (LVSR-IC, LVSR-Ej) as well as the LA (LASR-IC, and LASR-Ej). Atrioventricular SR during IC and Ej (AVSR-IC, AVSR-Ej) was calculated as the sum of the LV and LA values. Patients were classified and compared based on their EF into 19 (49%) with EF≥55%, and 21 (51%) with EF<55%. No significant differences were noted for age, sex, risk factors, and medications between both patients with EF≥55% and EF<55%. Compared to EF≥55%, patients with EF<55% had lower IVV (4.63±1.2 vs. 7.01±1.9 cm/s, P<0.001), LVSR-Ej (1±0.3 vs. 1.2±0.2, P=0.03), LASR-IC (1.3±0.6 vs. 1.9±1, P=0.03), LASR-Ej (1.5±0.5 vs. 2.6±1.3 s, P=0.001), AVSR-IC (2±0.8 vs. 2.7±1.06 s, P=0.023), and AVSR-Ej (2.5±0.6 vs. 3.9±1.1 s, <0.001). LVSR-IC, LVSR-Ej, LASR-IC, AVSR-IC, and IVV correlated with PCWP in only in EF<55%, with the strongest correlation noted for AVSR-IC (r=-0.72, <0.001). Other correlates with PCWP in EF<55% were E/e' and left atrial volume (r=0.47, 0.7, P=0.04, 0.001; respectively). Multivariate regression revealed that in patients with EF<55% AVSR-IC was the only independent predictor of PCWP. Finally, IVV correlated with LVSR-IC and LASR-IC and this correlation became strongest with AVSR-IC (r=0.77, 0.001).
CONCLUSION
The combined LV and LA longitudinal SR during IC as represented by AVSR-IC showed a strong correlation with PCWP in patients with depressed EF. The correlation between mitral annular IVV and PCWP in those patients can be a product of this combination and may a function of atrioventricular mechanical coupling.
背景
据报道，组织多普勒成像（TDI）测定的等容收缩期（IVV）二尖瓣环速度可预测射血分数降低（EF）的心力衰竭患者的肺毛细血管楔压（PCWP）。我们研究了应用彩色TDI测定的等容收缩期（IC）左心房（LA）和左心室（LV）纵向应变率（SR）预测有创测量的PCWP。
方法与结果
前瞻性研究了40例因心力衰竭症状就诊的患者[年龄：56±8岁，女性12例（30%），平均左心室射血分数（LVEF）：51±14%]。超声心动图检查后立即进行有创PCWP测量。对所有患者测量二尖瓣环IVV，测量LV在IC期和射血期的SR（LVSR-IC、LVSR-Ej）以及LA的SR（LASR-IC和LASR-Ej）。计算IC期和射血期房室SR（AVSR-IC、AVSR-Ej），即LV和LA数值之和。根据EF将患者分为两组：EF≥55%的患者19例（49%），EF<55%的患者21例（51%）。EF≥55%和EF<55%的两组患者在年龄、性别、危险因素和用药方面无显著差异。与EF≥55%的患者相比，EF<55%的患者IVV较低（4.63±1.2对7.01±1.9 cm/s，P<0.001），LVSR-Ej较低（1±0.3对1.2±0.2，P=0.03），LASR-IC较低（1.3±0.6对1.9±1，P=0.03），LASR-Ej较低（1.5±0.5对2.6±1.3 s，P=0.001），AVSR-IC较低（2±0.8对2.7±1.06 s，P=0.023），AVSR-Ej较低（2.5±0.6对3.9±1.1 s，P<0.001）。仅在EF<55%的患者中，LVSR-IC、LVSR-Ej、LASR-IC、AVSR-IC和IVV与PCWP相关，其中AVSR-IC相关性最强（r=-0.72，P<0.001）。EF<55%的患者中，与PCWP相关的其他因素为E/e'和左心房容积（r分别为0.47、0.7，P=0.04、0.001）。多因素回归分析显示，在EF<55%的患者中，AVSR-IC是PCWP的唯一独立预测因素。最后，IVV与LVSR-IC和LASR-IC相关，且与AVSR-IC相关性最强（r=0.77，P=0.001）。
结论
以AVSR-IC表示的IC期LV和LA纵向SR联合值与EF降低患者的PCWP密切相关。这些患者中二尖瓣环IVV与PCWP的相关性可能是这种联合作用的结果，可能是房室机械耦联的一种功能表现。
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