左心室射血分数保留且有心力衰竭症状患者的舒张期负荷超声心动图及生物标志物

Diastolic stress echocardiography and biomarkers in patients with preserved left ventricle ejection fraction and heart failure symptoms.

作者信息

Kubicius Andrzej, Bałys Mariusz, Ciampi Quirino, Picano Eugenio, Gąsior Zbigniew, Haberka Maciej

机构信息

Department of Cardiology in Cieszyn, Upper Silesia Medical Center, Medical University of Silesia, Katowice, Poland.

Department of Cardiology, School of Health Sciences, Medical University of Silesia, Katowice, Poland.

出版信息

Kardiol Pol. 2022;80(5):560-566. doi: 10.33963/KP.a2022.0070. Epub 2022 Mar 14.

DOI:10.33963/KP.a2022.0070

PMID:35285508

Abstract

BACKGROUND

Diastolic dysfunction (DD) is a diagnostic challenge in clinical practice.

AIM

Our study aimed to evaluate the value of diastolic stress echocardiography (DSE) and heart failure (HF) biomarkers in patients with preserved left ventricular ejection fraction (LVEF) and HF symptoms.

METHODS

All the consecutive patients with HF symptoms, preserved LVEF, and suspected DD were examined on transthoracic echocardiography (TTE) and DSE using the protocol according to the American Society of Echocardiography recommendations. Moreover, blood samples were taken 30 minutes before and after DSE for the following lab markers: N-terminal pro-B type natriuretic peptide (NT-proBNP), mid regional pro-atrial natriuretic peptide (MR-proANP), and serum soluble ST2 receptor (ST2).

RESULTS

The study group included 80 patients (mean [standard deviation, SD] age, 69 (8.1) years; 25% males) with dyspnea (New York Heart Association classification IIa - 53; IIb - 17; III - 10) and risk factors: hypertension (96%), diabetes (41%), obesity (56%), and known coronary artery disease (10%). The rest transthoracic echocardiography (TTE) showed preserved systolic function (mean [SD], LVEF 61.1 [10.5]%) and normal or indeterminate diastolic function. DSE revealed a positive result for diastolic dysfunction in 17 patients (21%). The receiver operating characteristic (ROC) analysis showed that age (the area under the curve [AUC], 0.725; P < 0.01), left atrial volume indexed for body surface area [LAVI] rest (AUC, 0.722; P < 0.01), E/e' rest (AUC, 0.790; P < 0.01), and baseline NT-proBNP (AUC, 0.713; P < 0.01) predicted positive DSE. Other parameters, including body mass index, baseline E/A, DT, or e' were not predictive of DSE results.

CONCLUSIONS

DSE revealed diastolic dysfunction in 21% of study patients and improved the diagnostic value of echocardiography. Rest NT-proBNP, but not MR-proANP and ST2, provided a diagnostic value for diastolic dysfunction.

摘要

背景

舒张功能障碍（DD）在临床实践中是一项诊断挑战。

目的

我们的研究旨在评估舒张期负荷超声心动图（DSE）和心力衰竭（HF）生物标志物在左心室射血分数（LVEF）保留且有HF症状的患者中的价值。

方法

所有连续的有HF症状、LVEF保留且疑似DD的患者均按照美国超声心动图学会的建议方案接受经胸超声心动图（TTE）和DSE检查。此外，在DSE检查前和检查后30分钟采集血样，检测以下实验室指标：N末端B型利钠肽原（NT-proBNP）、中段心房利钠肽前体（MR-proANP）和血清可溶性ST2受体（ST2）。

结果

研究组包括80例患者（平均[标准差，SD]年龄，69（8.1）岁；25%为男性），有呼吸困难症状（纽约心脏协会分级IIa - 53例；IIb - 17例；III - 10例）及危险因素：高血压（96%）、糖尿病（41%）、肥胖（56%）和已知冠状动脉疾病（10%）。其余经胸超声心动图（TTE）显示收缩功能保留（平均[SD]，LVEF 61.1[10.5]%），舒张功能正常或不确定。DSE显示17例患者（21%）舒张功能障碍结果为阳性。受试者工作特征（ROC）分析表明，年龄（曲线下面积[AUC]，0.725；P < 0.01）、体表面积校正的静息左心房容积指数[LAVI]（AUC，0.722；P < 0.01）、静息E/e'（AUC，0.790；P < 0.01）和基线NT-proBNP（AUC，0.713；P < 0.01）可预测DSE结果为阳性。其他参数，包括体重指数、基线E/A、DT或e'，均不能预测DSE结果。