Diastolic stress echocardiography: Hemodynamic validation and clinical significance of estimation of ventricular filling pressure with exercise
Diastolic stress echocardiography: Hemodynamic validation and clinical significance of estimation of ventricular filling pressure with exercise
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DOI：
10.1016/j.jacc.2006.02.042
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发表时间：
2006-05-02
影响因子：
24
通讯作者：
Marwick, TH
中科院分区：
文献类型：
--
作者：
Burgess, MI;Jenkins, C;Marwick, TH
目的 我们的研究试图验证运动期间的舒张期充盈多普勒指数 (E/E')，同时测量左心室舒张压 (LVDP)，调查其与运动能力的关联，并了解选择哪些患者进行测试。 背景 舒张早期传输速度与舒张早期组织速度的比率接近静息时的 LVDP，但对有创运动 E/E' 的验证有限方法对37例接受左心导管插入术的患者进行静息和仰卧位周期测功，测量舒张早期二尖瓣速度与舒张早期组织速度的比值。除了侵入性 LVDP 与估计 LVDP 之间的相关性外，还确定了休息和运动时识别 LVDP 升高（> 15 mm Hg）的不同截止值的准确性。还测量了 166 名患者在休息时和在最大跑步机运动后立即测量的舒张期充盈多普勒指数，以研究运动 E/E' 与运动能力（< 8 代谢当量 [MET]）之间的关联。 结果 在接受侵入性测量的患者中，9 名 (24%) 仅在运动期间出现 LVDP 升高。休息时 (r = 0.67) 和运动时 (r = 0.59) 的 E/E' 和 LVDP 之间存在良好的相关性，并且休息时和运动时的回归密切相关。受试者操作曲线分析表明，运动 E/E' 的截止值为 13，可识别出运动期间 LVDP 升高的患者。运动后 E/E' > 13 对于运动能力下降具有高度特异性 (90%)，即使在静息 E/E' 分类后，运动 E/E' 也允许对运动能力 < 8 MET 或 >= 8 MET 的患者进行分类。结论 舒张早期传输速度与 Earl) 的比率、舒张组织速度与运动期间侵入性测量的 LVDP 相关。它可以用来可靠地识别运动过程中 LVDP 升高和运动能力降低的患者。
OBJECTIVES Our study attempted to validate a Doppler index of diastolic filling (E/E') during exercise with simultaneously measured left vcntricular diastolic pressure (LVDP), investigate its association with exercise capacity, and understand which patients to select for testing.BACKGROUND The ratio of early diastolic transmittal velocity to early diastolic tissue velocity approximates LVDP at rest, but there is limited validation of exercise E/E' with invasive hemodynamic measurement, and its clinical Implications are unclear.METHODS The ratio of early diastolic transmitral velocity to early diastolic tissue velocity was measured at rest and during supine cycle ergometry in 37 patients undergoing left heart catheterization. In addition to correlation between invasive and estimated LVDP, the accuracy of different cutoffs for identification of elevated LVDP (> 15 mm Hg) was determined at both rest and exercise. Doppler index of diastolic filling was also measured at rest and immediately after maximal treadmill exercise in 166 patients to investigate the association between exercise E/E' and exercise capacity (< 8 metabolic equivalents [METs]).RESULTS In patients undergoing invasive measurement, nine (24%) had elevation of LVDP only during exercise. There was a good correlation between E/E' and LVDP at rest (r = 0.67) and during exercise (r = 0.59), and the regressions at rest and exercise corresponded closely. Receiver-operator curve analysis indicated that a cutoff value of 13 for exercise E/E' identified patients with an elevated LVDP during exercise. A post-exercise E/E' > 13 was highly specific (90%) for reduced exercise capacity, and even after classification of resting E/E', exercise E/E' permitted classification of patients with exercise capacity, < 8 METs or >= 8 METs.CONCLUSIONS The ratio of early diastolic transmittal velocity to earl), diastolic tissue velocity correlates with invasively measured LVDP during exercise. It can be used to reliably identify patients with elevated LVDP during exercise and reduced exercise capacity.