左心房储器应变提高了左心室射血分数保留患者中 2016 年 ASE/EACVI 舒张算法的诊断准确性：来自 KARUM 血流动力学数据库的见解。

Left atrial reservoir strain improves diagnostic accuracy of the 2016 ASE/EACVI diastolic algorithm in patients with preserved left ventricular ejection fraction: insights from the KARUM haemodynamic database.

机构信息

Department of Medicine, Cardiology Unit, Karolinska Institutet, D1:04, Eugeniavagen 3, Solna 171 64, Sweden.

Department of Clinical Physiology, Surgical and Perioperative sciences, Umeå University, Universitetstorget 4, Umeå 901 87, Sweden.

出版信息

Eur Heart J Cardiovasc Imaging. 2022 Aug 22;23(9):1157-1168. doi: 10.1093/ehjci/jeac036.

AIMS

This study aimed to investigate the incremental value offered by left atrial reservoir strain (LASr) to the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging (ASE/EACVI) diastolic algorithm to identify elevated left ventricular (LV) filling pressure in patients with preserved ejection fraction (EF).

METHODS AND RESULTS

Near-simultaneous echocardiography and right heart catheterization were performed in 210 patients with EF ≥50% in a large, dual-centre study. Elevated filling pressure was defined as invasive pulmonary capillary wedge pressure (PCWP) ≥15 mmHg. LASr was evaluated using speckle-tracking echocardiography. Diagnostic performance of the ASE/EACVI diastolic algorithm was validated against invasive reference and compared with modified algorithms incorporating LASr. Modest correlation was observed between E/e', E/A ratio, and LA volume index with PCWP (r = 0.46, 0.46, and 0.36, respectively; P < 0.001 for all). Mitral e' and TR peak velocity showed no association. The ASE/EACVI algorithm (89% feasibility, 71% sensitivity, 68% specificity) demonstrated reasonable ability (AUC = 0.69) and 68% accuracy to identify elevated LV filling pressure. LASr displayed strong ability to identify elevated PCWP (AUC = 0.76). Substituting TR peak velocity for LASr in the algorithm (69% sensitivity, 84% specificity) resulted in 91% feasibility, 81% accuracy, and stronger agreement with invasive measurements. Employing LASr as per expert consensus (71% sensitivity, 70% specificity) and adding LASr to conventional parameters (67% sensitivity, 84% specificity) also demonstrated greater feasibility (98% and 90%, respectively) and overall accuracy (70% and 80%, respectively) to estimate elevated PCWP.

CONCLUSIONS

LASr improves feasibility and overall accuracy of the ASE/EACVI algorithm to discern elevated filling pressures in patients with preserved EF.

目的

本研究旨在探讨左心房储存应变（LASr）对 2016 年美国超声心动图学会/欧洲心血管影像协会（ASE/EACVI）舒张功能算法的增量价值，以识别射血分数保留的患者（EF）中升高的左心室（LV）充盈压。

方法和结果

在一项大型双中心研究中，对 210 例 EF≥50%的患者进行了近同步超声心动图和右心导管检查。升高的充盈压定义为有创性肺毛细血管楔压（PCWP）≥15mmHg。使用斑点追踪超声心动图评估 LASr。验证了 ASE/EACVI 舒张功能算法对有创参考标准的诊断性能，并将其与包含 LASr 的改良算法进行了比较。E/e'、E/A 比值和左心房容积指数与 PCWP 之间存在适度相关性（r=0.46、0.46 和 0.36，均<0.001）。二尖瓣 e'和 TR 峰值速度与 PCWP 无相关性。ASE/EACVI 算法（89%的可行性，71%的敏感性，68%的特异性）显示出合理的能力（AUC=0.69），可识别 68%的升高的 LV 充盈压。LASr 显示出识别升高的 PCWP 的强大能力（AUC=0.76）。将 TR 峰值速度替代为算法中的 LASr（敏感性为 69%，特异性为 84%），可获得 91%的可行性、81%的准确性和与有创测量的更强一致性。根据专家共识使用 LASr（敏感性为 71%，特异性为 70%）和将 LASr 添加到常规参数中（敏感性为 67%，特异性为 84%）也显示出更高的可行性（分别为 98%和 90%）和整体准确性（分别为 70%和 80%），以估计升高的 PCWP。