Zhang Li, Cai Peiwei, Deng Yinlong, Lin Jiumin, Wu Muli, Xiao Zhongbo, Chu Zhengpei, Shi Qingfeng, Ye Fei, Hu Junhao, Yang Chao, Li Pengyang, Zhuang Shaochun, Wang Bin
Department of Cardiology, the First Affiliated Hospital of Shantou University Medical College, Shantou, China.
Clinical Research Center, the First Affiliated Hospital of Shantou University Medical College, Shantou, China.
Ann Transl Med. 2021 Oct;9(20):1587. doi: 10.21037/atm-21-5161.
Heart failure is a global health problem, and elevated left atrial pressure (LAP) is a precursor to identifying decompensated heart failure. At present, out-of-hospital monitoring of patients with heart failure is mostly based on the patient's symptoms and signs, and the use of non-invasive technology is scarce. In this study, a non-invasive ballistocardiography (BCG) device was used to collect thoracic vibration signals generated by heartbeat. We collected these signals from more than 1,000 adults, including those with different heart diseases, and used a sensor system and a composite index related to LAP recognition named the LAP-index, to analyze them. This study aimed to verify the reliability and accuracy of the LAP-index in identifying elevated LAP within heart failure patients.
We prospectively included 158 patients with various extent of diastolic function, some of whom had various underlying diseases, and collected BCG and echocardiographic data using a cross-section methodology. The BCG signal was recorded from multiple optical fiber vibration sensors placed on the back of each patient. We adopted the 2016 ASE/EACVI echocardiography guideline as the standard for determining LAP level from echocardiography parameters. To evaluate the diagnostic efficacy of the LAP-index, we drew a receiver operating characteristic (ROC) curve and calculated the area under the ROC curve (AUC).
The LAP-index of the 158 patients ranged from 6 to 32. Of them, 39 were diagnosed as high LAP by echocardiography, and 119 cases had normal or slightly elevated LAP. Comparison of the LAP-index results and echocardiographic results revealed the ROC c-statistic of the LAP-index for identifying high LAP was 0.86 (95% CI: 0.79-0.93; P<0.0001). When the LAP-index was at the best cut-off value of 15.5, the positive agreement rate between it and echocardiography LAP was 0.85, the negative agreement rate was 0.80, and the overall agreement rate was 0.81.
The sensor system and the LAP-index, a composite index derived from BCG, have high reliability and accuracy in identifying elevated LAP, which provides a novel possibility for the non-invasive detection of hemodynamic congestion in heart failure patients.
心力衰竭是一个全球性的健康问题，左心房压力（LAP）升高是识别失代偿性心力衰竭的先兆。目前，心力衰竭患者的院外监测主要基于患者的症状和体征，非侵入性技术的应用较少。在本研究中，使用一种非侵入性心冲击图（BCG）设备收集心跳产生的胸部振动信号。我们从1000多名成年人中收集了这些信号，包括患有不同心脏病的患者，并使用一个传感器系统和一个与LAP识别相关的复合指数（称为LAP指数）对其进行分析。本研究旨在验证LAP指数在识别心力衰竭患者LAP升高方面的可靠性和准确性。
我们前瞻性纳入了158例舒张功能程度不同的患者，其中一些患者患有各种基础疾病，并采用横断面方法收集了BCG和超声心动图数据。BCG信号由放置在每个患者背部的多个光纤振动传感器记录。我们采用2016年美国超声心动图学会/欧洲心血管影像学会（ASE/EACVI）超声心动图指南作为根据超声心动图参数确定LAP水平的标准。为了评估LAP指数的诊断效能，我们绘制了受试者工作特征（ROC）曲线并计算了ROC曲线下面积（AUC）。
158例患者的LAP指数范围为6至32。其中，39例经超声心动图诊断为高LAP，119例LAP正常或轻度升高。LAP指数结果与超声心动图结果的比较显示，LAP指数识别高LAP的ROC c统计量为0.86（95%CI：0.79-0.93；P<0.0001）。当LAP指数处于最佳截断值15.5时，其与超声心动图LAP的阳性一致率为0.85，阴性一致率为0.80，总体一致率为0.81。
传感器系统和源自BCG的复合指数LAP指数在识别LAP升高方面具有较高的可靠性和准确性，这为心力衰竭患者血流动力学充血的非侵入性检测提供了新的可能性。
