A novel minimally-invasive technique to predict pulmonary capillary wedge pressure utilizing jugular venous pressure and the tissue Doppler tricuspid/mitral annular velocities-猫眼课题宝

DOI：

10.1093/eurheartj/eht307.p660

发表时间：

2013-08

期刊：

European Heart Journal

影响因子：

39.3

通讯作者：

中科院分区：

医学1区

文献类型：

作者：

K. Uemura;T. Kawada;M. Sugimachi

目的：准确预测左心充盈压对心力衰竭(HF)患者的治疗至关重要。然而，二尖瓣环早期血流速度与组织多普勒二尖瓣环早期血流速度比值(E/Ea)等常规预测方法的可靠性并不令人满意。本研究的目的是验证我们新开发的利用颈静脉压(JVP)和三尖瓣环(ST)与二尖瓣环(Sm)的组织多普勒峰值收缩速度之比(Sm)来预测肺毛细血管楔压(PCWP)的方法。方法：在10只麻醉开胸犬上，用导管测量PCWP和JVP。采用经胸组织多普勒超声心动图测定ST、Sm和E/Ea。在不同的前负荷范围内，记录正常心脏、冠状动脉栓塞术左心衰和右心衰的PCWP、JVP、ST、Sm和E/Ea。结果：146组数据的回归分析显示，PCWP(2~40 mm Hg)与E/Ea(3~14)呈弱相关(图A)，而PCWP与JVP·ST/Sm(-1~32 mm Hg)密切相关(图B)。受试者操作特征(ROC)分析确定了使检测PCWP&GT；18 mm Hg的灵敏度和特异度之和最大化的临界值(图C)。E/EA&GT；6的敏感性为89%，特异性为73%。JVP·ST/Sm&gt；11 mm Hg的敏感性和特异性分别为90%和90%。JVP·ST/Sm的ROC曲线下面积(0.94)明显大于E/EA(0.79)(p&lt；0.001)。[图][1]图1结论：根据左、右心功能关系校正的JVP·ST/Sm可准确预测PCWP。我们预测PCWP的技术可能对心力衰竭患者的治疗有用。[1]：待定：是

Purpose: Accurate prediction of left heart filling pressure is critical to the management of patients with Heart Failure (HF). However, reliability of conventional prediction such as the ratio of early transmitral velocity to tissue Doppler mitral annular early diastolic velocity (E/Ea) is not satisfactory. Purpose of this study was to validate our newly developed technique to predict Pulmonary Capillary Wedge Pressure (PCWP) utilizing Jugular Venous Pressure (JVP) and the ratio of tissue Doppler peak systolic velocity of the tricuspid annulus (St) to that of the mitral annulus (Sm). Methods: In 10 anesthetized closed-chest dogs, PCWP and JVP were measured through catheters. St, Sm and E/Ea were measured by trans-thoracic tissue Doppler echocardiography. PCWP, JVP, St, Sm and E/Ea were recorded over a variable preload range in normal heart, in left HF induced by coronary artery embolization, and in right HF induced by pulmonary artery embolization. Results: Regression analysis of pooled 146 data sets indicated that PCWP (2–40 mmHg) and E/Ea (3–14) correlated weakly (Figure A), while PCWP and JVP·St/Sm (-1–32mmHg) correlated tightly (Figure B). Receiver-operating characteristic (ROC) analysis identified cutoffs that maximized the sum of sensitivity and specificity for detecting PCWP > 18 mmHg (Figure C). E/Ea >6 had 89% sensitivity and 73% specificity. JVP·St/Sm >11 mmHg had 90% sensitivity and 90% specificity. Area under ROC curve for JVP·St/Sm (0.94) was significantly larger than that for E/Ea (0.79) (p<0.001). ![Figure][1] Figure 1 Conclusions: JVP corrected by the relation between right and left ventricular functions, JVP·St/Sm, accurately predicts PCWP. Our technique to predict PCWP may be useful in the management of HF patients. [1]: pending:yes

A novel minimally-invasive technique to predict pulmonary capillary wedge pressure utilizing jugular venous pressure and the tissue Doppler tricuspid/mitral annular velocities

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