Intensive Care Unit U.O.C. Anestesia e Rianimazione, Department of Surgery, Padua University Hospital, Padua, Italy.
Institute of Anesthesia and Intensive Care, Department of Medicine (DIMED), Padua University Hospital, Padua, Italy.
J Crit Care. 2023 Aug;76:154281. doi: 10.1016/j.jcrc.2023.154281. Epub 2023 Mar 1.
The reliability of echocardiographic methods for the assessment of pulmonary capillary wedge pressure (PCWP) is still a matter of debate. Since its first description, the E/e' ratio has been regarded as a suitable method. The aim of this study is to evaluate the evidence of how E/e' effectively estimates PCWP and its diagnostic accuracy for elevated PCWP.
We systematically searched MEDLINE and Embase databases for studies investigating the agreement between E/e' and PCWP, from inception to July 2022. We limited our research to studies published from 2010 to date. Retrospective studies and studies on non-adult population were excluded.
Twenty-eight studies, involving a total of 1964 subjects, were included. The pooled analysis of the studies showed a modest correlation between E/e' and PCWP. The weighted average correlation (r) is 0.43 (95% CI 0.37-0.48). We found no significant differences between reduced and preserved ejection fraction groups. Thirteen studies analysed the diagnostic accuracy of E/e' for elevated PCWP. The AUC of receiver operating characteristic curves for PCWP >15 mmHg was estimated in the interval 0.6-0.91.
E/e' appears to have a modest correlation with PCWP and an acceptable accuracy for elevated PCWP. (PROSPERO number, CRD42022333462).
超声心动图方法评估肺毛细血管楔压（PCWP）的可靠性仍存在争议。自首次描述以来，E/e' 比值一直被认为是一种合适的方法。本研究旨在评估 E/e' 有效评估 PCWP 的证据及其对升高的 PCWP 的诊断准确性。
我们系统地检索了 MEDLINE 和 Embase 数据库，以评估从研究开始到 2022 年 7 月期间 E/e' 与 PCWP 之间的一致性的研究。我们将研究范围限于 2010 年至今发表的研究。排除了回顾性研究和非成人人群的研究。
共纳入 28 项研究，总计 1964 例患者。对研究的汇总分析显示，E/e' 与 PCWP 之间存在适度的相关性。加权平均相关性（r）为 0.43（95%CI 0.37-0.48）。我们未发现射血分数降低和保留组之间存在显著差异。有 13 项研究分析了 E/e' 对升高的 PCWP 的诊断准确性。PCWP>15mmHg 的受试者工作特征曲线的 AUC 估计值在 0.6-0.91 之间。
E/e' 与 PCWP 之间似乎存在适度的相关性，并且对升高的 PCWP 具有可接受的准确性。（PROSPERO 注册号，CRD42022333462）。
