Ultrasound Examination Center, Tokushima University Hospital, Tokushima, Japan.
Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan.
J Echocardiogr. 2024 Mar;22(1):25-33. doi: 10.1007/s12574-023-00623-x. Epub 2023 Sep 14.
Vector Flow Mapping (VFM) and Energy Loss (EL) evaluation are emerging echocardiographic techniques that offer detailed insights into cardiac function. This study aimed to explore the relationship between EL parameters and B-type natriuretic peptide (BNP) levels, a well-established marker of heart failure severity.
Our study prospectively enrolled 62 patients experiencing shortness of breath and suspected heart failure, who underwent echocardiography and had BNP levels measured between January 2018 and August 2020. Patients were stratified based on BNP levels, and their clinical and echocardiographic characteristics were evaluated. Univariate and multivariate regression analyses were performed to assess the correlation between BNP levels and various echocardiographic variables, including VFM parameters.
Patients were stratified into two groups based on their BNP levels: BNP < 200 pg/ml (n = 53) and BNP ≥ 200 pg/ml (n = 9). Patients with BNP ≥ 200 pg/ml presented significantly different clinical and echocardiographic characteristics, such as older age, larger left ventricular mass and volume indices, higher pulmonary artery systolic pressure, higher E/e' ratio, and larger EL parameters. Multivariate regression analysis demonstrated the E/e' ratio and ELA (EL during Atrial contraction phase/A wave ratio as significant determinants of logBNP. Receiver operating characteristic curve analysis showed ELA/A > 36.0 J/m as a significant predictor of high BNP with 89% sensitivity and 85% specificity. ELA/A demonstrated an incremental diagnostic value over elevated left atrial pressure for predicting high BNP (C statistic = 0.98 vs 0.74, P = 0.006).
This study provides novel insights into the potential utility of EL parameters as auxiliary indicators of cardiac load, thereby enhancing our understanding of heart failure.
向量流图（VFM）和能量损失（EL）评估是新兴的超声心动图技术，可提供有关心脏功能的详细信息。本研究旨在探讨 EL 参数与 B 型利钠肽（BNP）水平之间的关系，BNP 是心力衰竭严重程度的既定标志物。
我们的研究前瞻性纳入了 2018 年 1 月至 2020 年 8 月期间因呼吸困难和疑似心力衰竭而接受超声心动图检查和 BNP 水平检测的 62 例患者。根据 BNP 水平对患者进行分层，并评估其临床和超声心动图特征。进行单变量和多变量回归分析，以评估 BNP 水平与各种超声心动图变量（包括 VFM 参数）之间的相关性。
根据 BNP 水平将患者分为两组：BNP<200 pg/ml（n=53）和 BNP≥200 pg/ml（n=9）。BNP≥200 pg/ml 的患者具有明显不同的临床和超声心动图特征，例如年龄较大、左心室质量和容积指数较大、肺动脉收缩压较高、E/e' 比值较高以及 EL 参数较大。多变量回归分析表明，E/e' 比值和 ELA（心房收缩期/ A 波比的 EL）是 logBNP 的重要决定因素。ROC 曲线分析显示，ELA/A>36.0 J/m 是 BNP 升高的显著预测因子，其敏感性为 89%，特异性为 85%。ELA/A 对预测 BNP 升高的诊断价值优于左心房压升高（C 统计量分别为 0.98 和 0.74，P=0.006）。
本研究提供了关于 EL 参数作为心脏负荷辅助指标的潜在效用的新见解，从而增强了我们对心力衰竭的理解。
