Application of Guideline-Based Echocardiographic Assessment of Left Atrial Pressure to Heart Failure with Preserved Ejection Fraction.
Application of Guideline-Based Echocardiographic Assessment of Left Atrial Pressure to Heart Failure with Preserved Ejection Fraction.
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DOI：
10.1016/j.echo.2020.12.008
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发表时间：
2021-05
期刊：
影响因子：
--
通讯作者：
Patel RB
中科院分区：
文献类型：
--
作者：
Rethy L;Borlaug BA;Redfield MM;Oh JK;Shah SJ;Patel RB
早期、无创地识别射血分数保留的心力衰竭（HFpEF）合并淤血的患者，可能有助于及时调整去淤血治疗。2016年美国超声心动图学会/欧洲心血管影像协会指南提供了一种评估左心房压力（LAP）升高的算法；超声心动图LAP（echo - LAP）与HFpEF的临床状态和疾病进展的关联尚不清楚。
我们将磷酸二酯酶 - 5抑制剂改善射血分数保留的心力衰竭患者临床状态和运动能力（RELAX）试验的参与者按照预先指定的基于指南的echo - LAP类别分为4类中的1类：1）正常，2）升高，3）超声心动图检查时存在心房颤动（AF），或4）不确定。我们评估了echo - LAP类别与基线运动能力、运动能力变化以及24周内N末端B型利钠肽原（NT - proBNP）变化的关联。
在216名参与者中，199人进行了二尖瓣流入道多普勒超声心动图检查以进行LAP分类。echo - LAP升高（n = 81）或存在AF（n = 57）的参与者年龄较大，肾功能障碍患病率较高。与正常echo - LAP组（n = 28）相比，在调整基线值和临床协变量后，echo - LAP升高和AF各自独立地与24周内峰值耗氧量的更大幅度降低相关（echo - LAP升高的β系数：−1.55[95%置信区间：−2.59，−0.51]，p = 0.004；AF的β系数：−1.33[95%置信区间：−2.49，−0.17]，p = 0.03）。与正常echo - LAP相比，不确定的echo - LAP（n = 33）也独立地与24周时运动能力降低相关（β系数：−1.35[95%置信区间：−2.51，−0.19]，p = 0.02）。最后，与正常echo - LAP相比，echo - LAP升高和AF与24周内NT - proBNP升高显著相关。
在慢性HFpEF中，按照当代指南定义的echo - LAP升高、不确定的echo - LAP以及AF，与正常echo - LAP相比，各自独立地与运动能力降低相关。这些发现表明，在HFpEF中无创性LAP评估对于调整减轻淤血的治疗可能具有潜在的实用性。
Early, non-invasive identification of heart failure with preserved ejection fraction (HFpEF) patients with congestion may allow for timely tailoring of decongestive therapies. The 2016 American Society of Echocardiography / European Association of Cardiovascular Imaging guidelines provide an algorithm to assess for elevated left atrial pressure (LAP); the associations of echocardiographic LAP (echo-LAP) with clinical status and disease progression in HFpEF are unclear. We categorized participants in the Phosphodiesterase-5 Inhibition to Improve Clinical Status and Exercise Capacity in HFpEF (RELAX) trial into 1 of 4 pre-specified guideline-based echo-LAP categories: 1) normal, 2) elevated, 3) atrial fibrillation (AF) at the time of echocardiography, or 4) indeterminate. We evaluated the associations of echo-LAP categories with baseline exercise capacity, change in exercise capacity, and change in NT-proBNP over 24 weeks. Of 216 participants, 199 had mitral inflow Doppler echocardiography for LAP categorization. Participants with elevated echo-LAP (n=81) or AF (n=57) were older and had higher prevalence of kidney dysfunction. Compared with the normal echo-LAP group (n=28), elevated echo-LAP and AF were each independently associated with a greater reduction in peak oxygen consumption over 24 weeks after adjusting for baseline values and clinical covariates (β-coefficient for elevated echo-LAP: −1.55 [95% CI: −2.59, −0.51], p=0.004; β-coefficient for AF: −1.33 [95% CI: −2.49, −0.17], p=0.03). Indeterminate echo-LAP (n=33) was also independently associated with a reduction in exercise capacity at 24 weeks compared with normal echo-LAP (β-coefficient: −1.35 [95% CI: −2.51, −0.19], p=0.02). Finally, elevated echo-LAP and AF were significantly associated with increases in NT-proBNP over 24 weeks compared with normal echo-LAP. In chronic HFpEF, elevated echo-LAP and indeterminate echo-LAP, as defined by contemporary guidelines, and AF were each independently associated with a reduction in exercise capacity compared with normal echo-LAP. These findings suggest potential utility of non-invasive LAP assessment in HFpEF for tailoring treatments that decrease congestion.
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慢性（MAGGIC）心力衰竭风险评分的荟萃分析全球组：验证一种简单的工具，用于预测心力衰竭的发病率和死亡率，并保留了射血分数。
影响因子：
5.4
作者：
Rich JD;Burns J;Freed BH;Maurer MS;Burkhoff D;Shah SJ
通讯作者：
Shah SJ
影响因子：
9.7
作者：
Redfield, Margaret M.;Borlaug, Barry A.;Braunwald, Eugene
通讯作者：
Braunwald, Eugene
DOI：
10.1161/circheartfailure.114.001192
发表时间：
2014-07
期刊：
Circulation. Heart failure
影响因子：
--
作者：
Mohammed SF;Borlaug BA;McNulty S;Lewis GD;Lin G;Zakeri R;Semigran MJ;LeWinter M;Hernandez AF;Braunwald E;Redfield MM
通讯作者：
Redfield MM
影响因子：
6.2
作者：
Lancellotti, Patrizio;Galderisi, Maurizio;Popescu, Bogdan A.
通讯作者：
Popescu, Bogdan A.
影响因子：
6.2
作者：
Lang, Roberto M.;Badano, Luigi P.;Voigt, Jens-Uwe
通讯作者：
Voigt, Jens-Uwe