Smiseth Otto A, Fernandes Joao F, Ohte Nobuyuki, Wakami Kazuaki, Donal Erwan, Remme Espen W, Lamata Pablo
Institute for Surgical Research, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Rikshospitalet and University of Oslo, Sognsvannsveien 20, NO-0372 Oslo, Norway.
School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
Eur Heart J Cardiovasc Imaging. 2025 Jun 30;26(7):1184-1194. doi: 10.1093/ehjci/jeaf017.
To establish an imaging-based method to quantify left ventricular (LV) diastolic pressures.
In 115 patients suspected of coronary artery disease, LV pressure was measured by micromanometers and images by echocardiography. LV filling pressure was measured as LV pre-atrial contraction pressure (pre-A PLV). Based on previous observations, we hypothesized that pre-A PLV approximates the sum of minimum PLV and maximum transmitral pressure difference. Parameters used for pressure estimates included LV volumes and strain, left atrial strain, mitral flow velocities, systolic arterial cuff pressure, and body mass index. Minimum PLV was estimated by predictors identified in a derivative cohort (n = 81). Mitral pressure difference was calculated by a simplified Navier-Stokes equation. Accuracy of estimates of minimum PLV, pre-A PLV, and end-diastolic PLV was investigated in a testing cohort (n = 19). Patient-specific LV diastolic pressure curves were constructed by adjusting a reference curve according to pressure estimates at key diastolic events. There was good agreement between estimated and measured pre-A PLV: bias 0.0, limits of agreement < 3.1 mmHg (±1.96 SD). Estimated minimum PLV and end-diastolic PLV also showed good agreement with measured pressures. Furthermore, there was good agreement between measured and estimated LV diastolic pressure curves, quantified as mean LV diastolic pressure: bias 0.2, limits of agreement < 3.2 mmHg.
The proposed non-invasive method provided estimates of minimum PLV, pre-A PLV, and end-diastolic PLV, each reflecting different features of diastolic function. Additionally, it provided an estimate of the LV diastolic pressure curve. Validation in larger populations with different phenotypes is necessary to determine the validity of the method in clinical practice.
建立一种基于成像的方法来量化左心室（LV）舒张压。
在115例疑似冠心病患者中，通过微测压计测量左心室压力，通过超声心动图获取图像。左心室充盈压以左心室心房收缩前压力（pre - A PLV）来测量。基于先前的观察，我们假设pre - A PLV近似于最小PLV与最大二尖瓣压差之和。用于压力估计的参数包括左心室容积和应变、左心房应变、二尖瓣血流速度、收缩期动脉袖带压力和体重指数。最小PLV通过在一个衍生队列（n = 81）中确定的预测因子来估计。二尖瓣压差通过简化的纳维 - 斯托克斯方程计算。在一个测试队列（n = 19）中研究了最小PLV、pre - A PLV和舒张末期PLV估计值的准确性。通过根据关键舒张期事件的压力估计值调整参考曲线，构建了患者特异性的左心室舒张压曲线。估计的和测量的pre - A PLV之间具有良好的一致性：偏差为0.0，一致性界限<3.1 mmHg（±1.96 SD）。估计的最小PLV和舒张末期PLV与测量压力之间也显示出良好的一致性。此外，测量的和估计的左心室舒张压曲线之间具有良好的一致性，以平均左心室舒张压量化：偏差为0.2，一致性界限<3.2 mmHg。
所提出的非侵入性方法提供了最小PLV、pre - A PLV和舒张末期PLV的估计值，每个值都反映了舒张功能的不同特征。此外，它还提供了左心室舒张压曲线的估计值。在具有不同表型的更大人群中进行验证对于确定该方法在临床实践中的有效性是必要的。
