Echo-Doppler estimation of left ventricular filling pressure: results of themulticentre EACVI Euro-Filling study
Echo-Doppler estimation of left ventricular filling pressure: results of themulticentre EACVI Euro-Filling study
复制标题
DOI：
10.1093/ehjci/jex067
复制
发表时间：
2017-09-01
影响因子：
6.2
通讯作者：
Popescu, Bogdan A.
中科院分区：
文献类型：
--
作者：
Lancellotti, Patrizio;Galderisi, Maurizio;Popescu, Bogdan A.
目的本欧洲填充报告旨在比较2009年和2016年超声心动图分级算法预测侵入性测量左心室充盈压（LVFP）的诊断准确性。方法和结果共159例患者同时接受LVFP和LV舒张末期压（LVEDP）侵入性测量的回声估计值的评价，在9个EACVI中心入组。39例（25%）患者左室射血分数降低（< 50%），77例（64%）NYHA >= II，85例（53%）患有冠状动脉疾病。64例（40%）患者LVEDP升高（>= 15 mmHg）。单独来看，LVFP的所有超声心动图多普勒估计值（E/A，E/e '，左心房容积，三尖瓣反流射流速度）与LVEDP轻微相关。根据2016年的建议，65%的无创LVFP估计值正常的患者LVEDP正常，而79%的无创LVFP升高的患者LVEDP升高。根据2009年的建议，68%的无创LVFP正常的患者LVEDP正常，而55%的无创LVFP升高的患者LVEDP升高。2016年建议（敏感性75%，特异性74%，阳性预测值39%，阴性预测值93%，AUC 0.78）确定了侵入性LVEDP升高的患者略好（>= 15 mmHg），与2009年的建议相比（敏感性43%，特异性75%，阳性预测值49%，阴性预测值71%，AUC 0.68）。结论目前的欧填充研究表明，2016年新的无创评估LVFP的建议相当可靠且临床有用，在估计侵入性LVEDP方面上级2009年的建议。
Aims The present Euro-Filling report aimed at comparing the diagnostic accuracy of the 2009 and 2016 echocardiographic grading algorithms for predicting invasively measured left ventricular filling pressure (LVFP).Method and results A total of 159 patients who underwent simultaneous evaluation of echo estimates of LVFP and invasive measurements of LV end-diastolic pressure (LVEDP) were enrolled at nine EACVI centres. Thirty-nine (25%) patients had a reduced LV ejection fraction (< 50%), 77 (64%) were in NYHA >= II, and 85 (53%) had coronary artery disease. Sixty-four (40%) patients had elevated LVEDP (>= 15 mmHg). Taken individually, all echocardiographic Doppler estimates of LVFP (E/A, E/e', left atrial volume, tricuspid regurgitation jet velocity) were marginally correlated with LVEDP. By using the 2016 recommendations, 65% of patients with normal non-invasive estimate of LVFP had normal LVEDP, while 79% of those with elevated non-invasive LVFP had elevated invasive LVEDP. By using 2009 recommendations, 68% of the patients with normal non-invasive LVFP had normal LVEDP, while 55% of those with elevated non-invasive LVFP had elevated LVEDP. The 2016 recommendations (sensitivity 75%, specificity 74%, positive predictive value 39%, negative predictive value 93%, AUC 0.78) identified slightly better patients with elevated invasive LVEDP (>= 15 mmHg) as compared with the 2009 recommendations (sensitivity 43%, specificity 75%, positive predictive value 49%, negative predictive value 71%, AUC 0.68).Conclusion The present Euro-Filling study demonstrates that the new 2016 recommendations for assessing LVFP noninvasively are fairly reliable and clinically useful, as well as superior to the 2009 recommendations in estimating invasive LVEDP.