The significance of mitral and tricuspid valve systolic lateral annular velocities in the diagnosis of acute pulmonary embolism in patients with chronic heart failure.
The significance of mitral and tricuspid valve systolic lateral annular velocities in the diagnosis of acute pulmonary embolism in patients with chronic heart failure.
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DOI：
10.5114/aoms.2014.40732
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发表时间：
2014-02-24
期刊：
影响因子：
--
通讯作者：
Pruszczyk P
中科院分区：
文献类型：
--
作者：
Gromadziński L;Targoński R;Januszko-Giergielewicz B;Ostrowski P;Pruszczyk P
慢性心力衰竭（CHF）患者的急性肺栓塞（APE）的诊断仍然是一项困难的任务，尽管成像技术的完善。本研究的目的是评估组织多普勒成像（TDI）测量三尖瓣和二尖瓣收缩期瓣环运动速度在疑似PE的CHF患者中的价值。该研究纳入了75例既往诊断为CHF的患者，这些患者因静息呼吸困难而入院，最大三尖瓣返流压差（TRPG）≥ 35 mm Hg，D-二聚体检测阳性。对所有受试者进行螺旋计算机断层扫描（sCT）以确认APE。35例患者（PE+）诊断为急性肺栓塞，40例患者（PE-）被排除。进行组织多普勒成像以测量二尖瓣（SmLV）和三尖瓣（SmRV）的最大收缩期外侧瓣环速度以及SmRV/SmLV比值。发现PE+受试者的SmLV高于PE-受试者（6.0 cm/s（2.0-13.8 cm/s）vs. 4.2 cm/s（1.3-9.1 cm/s），p = 0.003）。SmRV/SmLV比值分别为1.05（0.50-2.50）和1.56（0.62-4.30）（p < 0.0001）。SmLV和SmRV/SmLV诊断APE的ROC曲线下面积分别为0.700和0.789。在多变量logistic回归分析中，仅SmRV/SmLV具有统计学显著性，APE的比值比为6.26（95% CI：1.53-25.59; p = 0.009）。三尖瓣外侧环和二尖瓣环的组织多普勒成像是一种有用的临床工具，可以帮助识别CHF患者的PE。符合这些标准的患者应考虑进行进一步的诊断研究以确认PE。
The diagnosis of acute pulmonary embolism (APE) in patients with chronic heart failure (CHF) remains a difficult task, despite the refinement of imaging techniques. The goal of this study was to assess the value of measuring tricuspid and mitral valve systolic annular velocities in CHF patients with suspected PE by tissue Doppler imaging (TDI). The study included 75 patients with previously diagnosed CHF, admitted due to resting dyspnea, with a maximum tricuspid regurgitation pressure gradient (TRPG) of ≥ 35 mm Hg and positive D-dimer assay. Spiral computed tomography (sCT) was performed on all subjects to confirm APE. Acute pulmonary embolism was diagnosed in 35 patients (PE+), and excluded in 40 others (PE–). Tissue Doppler imaging was performed to measure maximum systolic lateral annular velocities in the mitral (SmLV) and tricuspid (SmRV) valves, as well as the SmRV/SmLV ratio. PE+ subjects were found to have higher SmLV than PE– subjects (6.0 cm/s (2.0–13.8 cm/s) vs. 4.2 cm/s (1.3–9.1 cm/s), p = 0.003). SmRV/SmLV ratios were 1.05 (0.50–2.50) and 1.56 (0.62–4.30), respectively (p < 0.0001). Areas under ROC curves for diagnosis of APE were 0.700 for SmLV and 0.789 for SmRV/SmLV. In multivariate logistic regression analysis, only SmRV/SmLV was statistically significant, with an odds ratio for APE of 6.26 (95% CI: 1.53–25.59; p = 0.009). Tissue Doppler imaging of the lateral tricuspid and mitral annuli is a useful clinical tool that can help identify PE in CHF patients. Those patients who fulfill these criteria should be considered for further diagnostic studies to confirm PE.
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DOI：
10.1016/j.echo.2007.02.004
发表时间：
2007-10-01
影响因子：
6.5
作者：
Gurudevan, Swaminatha V.;Malouf, Philip J.;Blanchard, Daniel G.
通讯作者：
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DOI：
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发表时间：
2003-12-01
期刊：
European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology
影响因子：
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作者：
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影响因子：
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作者：
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DOI：
10.1016/s0894-7317(99)70145-8
发表时间：
1999-11-01
影响因子：
6.5
作者：
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通讯作者：
Kim, HC