Low level exercise echocardiography helps diagnose early stage heart failure with preserved ejection fraction: a study of echocardiography versus catheterization
Low level exercise echocardiography helps diagnose early stage heart failure with preserved ejection fraction: a study of echocardiography versus catheterization
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DOI：
10.1007/s00392-016-1039-0
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发表时间：
2017-03-01
影响因子：
5
通讯作者：
Isnard, Richard
中科院分区：
文献类型：
--
作者：
Hammoudi, Nadjib;Laveau, Florent;Isnard, Richard
运动时左心室舒张末期压（LVEDP）升高是左心室射血分数（LVEF）正常的心力衰竭的早期体征。LVEDP的异常运动增加是非线性的，大多数变化发生在低水平的运动。关于这种情况的非侵入性方法的数据很少。我们的目的是评估E/e'，以评估低水平运动LVEDP，使用直接侵入性测量作为参考方法。60例LVEF > 50%的患者前瞻性地接受了运动心导管检查和超声心动图检查。E/e'在休息和低水平运动时测量。LVEDP异常定义为> 16 mmHg。有冠状动脉疾病史和/或LV形态异常的患者被归类为患有明显心脏病（CD）。34例（57%）患者仅在运动期间LVEDP升高。LVEDP的大部分变化发生在首次运动水平（25 W）之后。静息和运动时LVEDP与室间隔E/e'之间存在相关性。横向E/e'和E/平均e'比值与LVEDP相关性较差。在整个人群中，25 W时的运动室间隔E/e'对异常运动LVEDP具有最佳准确性，曲线下面积（AUC）= 0.79。然而，尽管低水平运动室间隔E/e'在CD患者中具有较高的准确性（n = 26，AUC = 0.96），但E/e'与无CD患者的LVEDP无关（n = 34）。低水平运动室间隔E/e'对于预测LVEF保留和明显CD患者的异常运动LVEDP有价值。然而，这种新的诊断方法在左室形态正常且无冠状动脉疾病的患者中似乎不可靠。
Increased left ventricular end-diastolic pressure (LVEDP) with exercise is an early sign of heart failure with preserved left ventricular ejection fraction (LVEF). The abnormal exercise increase in LVEDP is nonlinear, with most change occurring at low-level exercise. Data on non-invasive approach of this condition are scarce. Our objective was assessing E/e' to estimate low level exercise LVEDP using a direct invasive measurement as the reference method.Sixty patients with LVEF > 50 % prospectively underwent both exercise cardiac catheterization and echocardiography. E/e' was measured at rest and during low-level exercise. Abnormal LVEDP was defined as > 16 mmHg. Patients with a history of coronary artery disease and/or abnormal LV morphology were classified as having apparent cardiac disease (CD). Thirty-four (57 %) patients had elevated LVEDP only during exercise. Most of the change in LVEDP occurred since the first exercise level (25 W). There was a correlation between LVEDP and septal E/e' at rest and during exercise. Lateral E/e' and E/average e' ratio had worse correlations with LVEDP. In the whole population, exercise septal E/e' at 25 W had the best accuracy for abnormal exercise LVEDP, area under curve (AUC) = 0.79. However, while low-level exercise septal E/e' had a high accuracy in CD patients (n = 26, AUC = 0.96), E/e' was not linked to LVEDP in patients without CD (n = 34).Low-level exercise septal E/e' is valuable for predicting abnormal exercise LVEDP in patients with preserved LVEF and apparent CD. However, this new diagnosis approach appears not reliable in patients with normal LV morphology and without coronary artery disease.