Murat Yazici Mümin, Parça Nurullah, Hamdioğlu Enes, Kaçan Meryem, Yavas I Özcan, Bilir Özlem
Recep Tayyip Erdoğan University Training and Research Hospital, Department of Emergency Medicine, Rize, Türkiye.
West J Emerg Med. 2025 Jan;26(1):1-9. doi: 10.5811/westjem.21272.
Spectral Doppler echocardiography is used to evaluate diastolic dysfunction of the heart. However, it is difficult to assess diastolic function with this modality in emergency department (ED) settings. Based on the hypothesis that E-point septal separation (EPSS) measured by M-mode in the parasternal long-axis (PSLA) view may facilitate the assessment of diastolic function in emergency patient care, we aimed to investigate whether EPSS measured by M-mode in the PSLA view correlates with spectral Doppler assessment in patients with grade 1 diastolic dysfunction.
We performed this prospective, observational, single-center study was performed in the ED of a tertiary training and research hospital. All patients who presented to the emergency critical care unit with symptoms of heart failure were evaluated by the cardiology department, had grade 1 diastolic dysfunction confirmed by the cardiology department, and did not meet any of the study's exclusion criteria. The study population of 40 (included rate 14%) was formed after the exclusion criteria were applied to 285 patients who met these conditions. Patients included in the study underwent spectral Doppler measurements in the apical four-chamber (A4C) view followed by M-mode measurements in the PSLA view. We then compared the measurements.
The correlation between the early diastolic velocity of the mitral inflow to the late diastolic velocity (E/A) ratio in spectral Doppler measurements and the EPSS/ A-point septal separation (APSS) ratio in M-mode was strong (correlation coefficient 0.677, = 0.001). Similarly, the correlation between E in spectral Doppler measurements and the EPSS/APSS ratio in M-mode measurements was also moderately strong (correlation coefficient 0.557, = 0.001).
A significant correlation exists between the M-mode EPSS/APSS ratio measurement in the PSLA view and the spectral Doppler E/A ratio measurement in the A4C window to evaluate grade 1 diastolic dysfunction. This association suggests that M-mode measurements in the PSLA may be used in diastolic dysfunction.
频谱多普勒超声心动图用于评估心脏舒张功能障碍。然而，在急诊科环境中，使用这种方式评估舒张功能存在困难。基于这样的假设，即通过胸骨旁长轴（PSLA）视图中的M型测量的E点室间隔分离（EPSS）可能有助于在急诊患者护理中评估舒张功能，我们旨在研究在PSLA视图中通过M型测量的EPSS与1级舒张功能障碍患者的频谱多普勒评估是否相关。
我们在一家三级培训和研究医院的急诊科进行了这项前瞻性、观察性、单中心研究。所有因心力衰竭症状就诊于急诊重症监护病房的患者均由心脏病科进行评估，经心脏病科确诊为1级舒张功能障碍，且不符合任何研究排除标准。在将排除标准应用于285名符合这些条件的患者后，形成了40名（纳入率14%）的研究人群。纳入研究的患者先在心尖四腔（A4C）视图中进行频谱多普勒测量，然后在PSLA视图中进行M型测量。然后我们比较了测量结果。
频谱多普勒测量中二尖瓣流入早期舒张速度与晚期舒张速度（E/A）比值与M型测量中的EPSS/A点室间隔分离（APSS）比值之间的相关性很强（相关系数0.677，P = 0.001）。同样，频谱多普勒测量中的E与M型测量中的EPSS/APSS比值之间的相关性也中等强度（相关系数0.557，P = 0.001）。
在PSLA视图中进行的M型EPSS/APSS比值测量与在A4C窗口中进行的频谱多普勒E/A比值测量之间存在显著相关性，以评估1级舒张功能障碍。这种关联表明，PSLA中的M型测量可用于舒张功能障碍的评估。
