平面 MUGA 衍生参数对冠心病心力衰竭患者 HFpEF 的诊断价值。

Diagnostic value of parameters derived from planar MUGA for detecting HFpEF in coronary artery disease patients.

机构信息

Department of Cardiology, Zaozhuang Municipal Hospital, Zaozhuang, 277100, Shandong, China.

Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, 99 Huaihai West Road, Xuzhou, 221004, Jiangsu, China.

出版信息

BMC Cardiovasc Disord. 2023 Jan 19;23(1):35. doi: 10.1186/s12872-023-03061-w.

DOI:10.1186/s12872-023-03061-w

PMID:36658476

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9850674/

Abstract

BACKGROUND

In recent years, heart failure with preserved ejection fraction (HFpEF) has received increasing clinical attention. To investigate the diagnostic value of diastolic function parameters derived from planar gated blood-pool imaging (MUGA) for detecting HFpEF in coronary atherosclerotic heart disease (coronary artery disease, CAD) patients.

METHODS

Ninety-seven CAD patients with left ventricular ejection fraction ≥ 50% were included in the study. Based on the left ventricular end-diastolic pressure (LVEDP), the patients were divided into the HFpEF group (LVEDP ≥ 16 mmHg, 47 cases) and the normal LV diastolic function group (LVEDP < 16 mmHg, 50 cases). Diastolic function parameters obtained by planar MUGA include peak filling rate (PFR), filling fraction during the first third of diastole (1/3FF), filling rate during the first third of diastole (1/3FR), mean filling rate during diastole (MFR), and peak filling time (TPF). Echocardiographic parameters include left atrial volume index (LAVI), peak tricuspid regurgitation velocity (peak TR velocity), transmitral diastolic early peak inflow velocity (E), average early diastolic velocities of mitral annulars (average e'), average E/e' ratio. The diastolic function parameters obtained by planar MUGA were compared with those obtained by echocardiography to explore the clinical value of planar MUGA for detecting HFpEF.

RESULTS

The Receiver-operating characteristic curve analysis of diastolic function parameters obtained from planar MUGA and echocardiography to detect HFpEF showed that: among the parameters examined by planar MUGA, the area under the curve (AUC) of PFR, 1/3FF, 1/3FR, MFR and TPF were 0.827, 0.662, 0.653, 0.663 and 0.809, respectively. Among the echocardiographic parameters, the AUCs for average e', average E/e' ratio, peak TR velocity, and LAVI values were 0.747, 0.706, 0.735, and 0.633. The combination of PFR and TPF showed an AUC of 0.856. PFR combined with TPF value demonstrated better predictive value than average e' (Z = 2.020, P = 0.043).

CONCLUSION

Diastolic function parameters obtained by planar MUGA can be used to diagnose HFpEF in CAD patients. PFR combined with TPF was superior to the parameters obtained by echocardiography and showed good sensitivity and predictive power for detecting HFpEF.

摘要

背景

近年来，射血分数保留的心力衰竭（HFpEF）越来越受到临床关注。本研究旨在探讨平面门控心血池成像（MUGA）获得的舒张功能参数对冠心病（CAD）患者 HFpEF 的诊断价值。

方法

本研究纳入 97 例左心室射血分数≥50%的 CAD 患者。根据左心室舒张末期压（LVEDP），将患者分为 HFpEF 组（LVEDP≥16mmHg，47 例）和正常左室舒张功能组（LVEDP＜16mmHg，50 例）。平面 MUGA 获得的舒张功能参数包括峰值充盈率（PFR）、舒张早期 1/3 充盈分数（1/3FF）、舒张早期 1/3 充盈率（1/3FR）、舒张中期平均充盈率（MFR）和充盈时间峰值（TPF）。超声心动图参数包括左心房容积指数（LAVI）、三尖瓣反流峰值速度（peak TR velocity）、二尖瓣舒张早期峰值流速（E）、二尖瓣环舒张早期平均速度（average e'）、平均 E/e'比值。比较平面 MUGA 与超声心动图获得的舒张功能参数，探讨平面 MUGA 对 HFpEF 的临床诊断价值。

结果

平面 MUGA 和超声心动图检测 HFpEF 舒张功能参数的受试者工作特征曲线分析显示，在平面 MUGA 检测的参数中，PFR、1/3FF、1/3FR、MFR 和 TPF 的曲线下面积（AUC）分别为 0.827、0.662、0.653、0.663 和 0.809。超声心动图参数中，average e'、average E/e'比值、peak TR velocity 和 LAVI 值的 AUC 分别为 0.747、0.706、0.735 和 0.633。PFR 和 TPF 的联合 AUC 为 0.856。PFR 联合 TPF 值的预测价值优于 average e'（Z=2.020，P=0.043）。