Do Additional Echocardiographic Variables Increase the Accuracy of E/e′ for Predicting Left Ventricular Filling Pressure in Normal Ejection Fraction? An Echocardiographic and Invasive Hemodynamic Study
Do Additional Echocardiographic Variables Increase the Accuracy of E/e′ for Predicting Left Ventricular Filling Pressure in Normal Ejection Fraction? An Echocardiographic and Invasive Hemodynamic Study
复制标题
DOI：
10.1016/j.echo.2009.11.015
复制
发表时间：
2010-02-01
影响因子：
6.5
通讯作者：
Lakkis, Nasser
中科院分区：
文献类型：
--
作者：
Dokainish, Hisham;Nguyen, John S.;Lakkis, Nasser
背景资料：在左室射血分数（LVEFs）>50%的患者中，将左房容积指数（LAVi）或肺动脉收缩压（PAP）与二尖瓣早期血流速度/二尖瓣环血流速度比值（E/e '）相加来估计左室充盈压的资料较少。超声心动图变量与侵入性测量的左室房前收缩压（pre-A）进行比较。结果：在研究的122例患者中（平均年龄55 ± 9岁，平均LVEF 61 ± 6%），67例（55%）为女性，108例（88%）有高血压，79例（65%）在导管插入术时有明显的冠状动脉疾病。与LAVi（R = 0.49，P <0.001）和PAP（R = 0.48，P <0.001）相比，E/e'与pre-A（R = 0.63，P <0.0001）显著相关。E/E' > 13的敏感性为70%，特异性为93%（曲线下面积[AUC]，0.82; P < .0001），LAVi > 31 mL/m2的敏感性为78%，特异性为76%（AUC，0.80，P < .001），并且PAP > 28 mm Hg对于pre-A > 15 mm Hg具有80%的灵敏度和64%的特异性（AUC，0.77，P < .001）。对于E/e' = 8至13，添加LAVi > 31 mL/m（2）可显着增加单独E/e' > 13的准确性（灵敏度，87%;特异性，88%; AUC，0.89;比较P = 0.01）。然而，在E/e' = 8 ~ 13时增加PAP > 28 mm Hg并不能显著增加单独E/e' > 13的准确性（AUC，0.82;灵敏度，82%;特异性，72%; P = NS用于比较）。在保留LVEFs的患者中，将LAVi > 31 mL/m2添加到E/e'（当E/e'在灰色区域时，但当E/e'> 13时不显著）显著增加了单独E/e'用于估计LV充盈压的准确性。这些数据支持使用多个而不是任何单个多普勒超声心动图参数来准确评估LV舒张功能的概念。（J Am Soc Echocardiogr 2010;23：156-61.）
Background: There are few data on adding left atrial volume index (LAVi) or pulmonary artery systolic pressure (PAP) to the ratio of early mitral inflow to mitral annular velocity (E/e') for the estimation of left ventricular (LV) filling pressure in patients with preserved LV ejection fractions (LVEFs) (>50%).Methods: Patients underwent echocardiography within 20 minutes of cardiac catheterization. Echocardiographic variables were compared with invasively measured LV preatrial contraction pressure (pre-A).Results: Of the 122 patients studied (mean age, 55+/-9 years; mean LVEF, 61+/-6%), 67 (55%) were women, 108 (88%) had hypertension, and 79 (65%) had significant coronary artery disease at catheterization. E/e' was significantly correlated with pre-A (R = 0.63, P < .0001) compared with LAVi (R = 0.49, P < .001) and PAP (R = 0.48, P < .001). E/e' > 13 had sensitivity of 70% and specificity of 93% (area under the curve [AUC], 0.82; P < .0001), LAVi > 31 mL/m(2) had sensitivity of 78% and specificity of 76% (AUC, 0.80, P < .001), and PAP > 28 mm Hg had sensitivity of 80% and specificity of 64% for pre-A > 15 mm Hg (AUC, 0.77, P < .001). Adding LAVi > 31 mL/m(2) for E/e' = 8 to 13 significantly increased the accuracy of E/e' > 13 alone (sensitivity, 87%; specificity, 88%; AUC, 0.89; P = .01 for comparison). However, adding PAP > 28 mm Hg for E/e' = 8 to 13 did not significantly increase the accuracy of E/e' > 13 alone (AUC, 0.82; sensitivity, 82%; specificity, 72%; P = NS for comparison).Conclusions: In patients with preserved LVEFs, adding LAVi > 31 mL/m(2) to E/e' (when E/e' was in the gray zone, but not when E/e' was > 13) significantly increased the accuracy of E/e' alone for the estimation of LV filling pressure. These data support the notion of using several, rather than any single, Doppler echocardiographic parameter for the accurate assessment of LV diastolic function. (J Am Soc Echocardiogr 2010;23:156-61.)