一种整合心房维度以鉴别运动员心脏与致心律失常性右室心肌病的新型诊断评分系统。
A Novel Diagnostic Score Integrating Atrial Dimensions to Differentiate between the Athlete's Heart and Arrhythmogenic Right Ventricular Cardiomyopathy.
作者信息
Rossi Valentina A, Niederseer David, Sokolska Justyna M, Kovacs Boldizsar, Costa Sarah, Gasperetti Alessio, Brunckhorst Corinna, Akdis Deniz, Tanner Felix C, Duru Firat, Schmied Christian M, Saguner Ardan M
机构信息
Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, 8091 Zurich, Switzerland.
Department of Cardiovascular Imaging, Institute of Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland.
出版信息
J Clin Med. 2021 Sep 10;10(18):4094. doi: 10.3390/jcm10184094.
OBJECTIVE
The 2010 Task Force Criteria (TFC) have not been tested to differentiate ARVC from the athlete's heart. Moreover, some criteria are not available (myocardial biopsy, genetic testing, morphology of ventricular tachycardia) or subject to interobserver variability (right ventricular regional wall motion abnormalities) in clinical practice. We hypothesized that atrial dimensions are useful and robust to differentiate between both entities and proposed a new diagnostic score based upon readily available parameters including echocardiographic atrial dimensions.
METHODS
In this observational study, 21 patients with definite ARVC were matched for age, gender and body mass index to 42 athletes. Based on ROC analysis, the following parameters were included in the score: indexed right/left atrial volumes ratio (RAVI/LAVI ratio), NT-proBNP, RVOT measurements (PLAX and PSAX BSA-corrected), tricuspid annular motion (TAM), precordial TWI and depolarization abnormalities according to TFC.
RESULTS
ARVC patients had a higher RAVI/LAVI ratio (1.76 ± 1.5 vs. 0.87 ± 0.2, < 0.001), lower right ventricular function (fac: 29 ± 10.1 vs. 42.2 ± 5%, < 0.001; TAM: 19.8 ± 5.4 vs. 23.8 ± 3.8 mm, = 0.001) and higher serum NT-proBNP levels (345 ± 612 vs. 48 ± 57 ng/L, < 0.001). Our score showed a good performance, which is comparable to the 2010 TFC using those parameters, which are available in routine clinical practice (AUC93%, < 0.001 (95%CI 0.874-0.995) vs. AUC97%, < 0.001 (95%CI 0.93-1.00). A score of 6/12 points yielded a specificity of 91% and an improved sensitivity of 67% for ARVC diagnosis as compared to a sensitivity of 41% for the abovementioned readily available 2010 TFC.
CONCLUSIONS
ARVC patients present with significantly larger RA compared to athletes, resulting in a greater RAVI/LAVI ratio. Our novel diagnostic score includes readily available clinical parameters and has a high diagnostic accuracy to differentiate between ARVC and the athlete's heart.
目的
2010年工作组标准（TFC）尚未经过检验以区分致心律失常性右室心肌病（ARVC）与运动员心脏。此外，一些标准在临床实践中不可用（心肌活检、基因检测、室性心动过速形态）或存在观察者间差异（右室局部室壁运动异常）。我们假设心房大小对于区分这两种情况是有用且可靠的，并基于包括超声心动图心房大小在内的易于获得的参数提出了一种新的诊断评分。
方法
在这项观察性研究中，将21例确诊的ARVC患者按年龄、性别和体重指数与42名运动员进行匹配。基于ROC分析，评分中纳入了以下参数：右/左心房容积指数比（RAVI/LAVI比）、N末端脑钠肽前体（NT-proBNP）、右室流出道测量值（经体表面积校正的胸骨旁长轴切面和胸骨旁短轴切面测量值）、三尖瓣环运动（TAM）、胸前导联T波倒置（TWI）以及根据TFC的去极化异常。
结果
ARVC患者的RAVI/LAVI比更高（1.76±1.5对0.87±0.2，<0.001），右室功能更低（FAC：29±10.1%对42.2±5%，<0.001；TAM：19.8±5.4对23.8±3.8mm，=0.001），血清NT-proBNP水平更高（345±612对48±57ng/L，<0.001）。我们的评分表现良好，与使用常规临床实践中可用的那些参数的2010年TFC相当（AUC 93%，<0.001（95%CI 0.874 - 0.995）对AUC 97%，<0.001（95%CI 0.93 - 1.00）。与上述易于获得的2010年TFC的41%的敏感性相比，12分制中得6分对ARVC诊断的特异性为91%，敏感性提高到67%。
结论
与运动员相比，ARVC患者的右心房明显更大，导致RAVI/LAVI比更高。我们新的诊断评分包括易于获得的临床参数，对区分ARVC和运动员心脏具有很高的诊断准确性。
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