The purpose of this study was to investigate the reliability of an algorithmic classification system using invasively measured left atrial pressure (LAP) in a large-scale cohort.
The authors enrolled 1,967 patients (age 68 ± 10 years) whose LAP was directly measured within the left atrium during catheter ablation for atrial fibrillation. Patients were classified into 3 groups based on the echocardiographic algorithm: normal (group N, n = 1,282), undetermined (group U, n = 160), and elevated (group E, n = 346) LAP groups. Invasively measured LAP and echocardiographic parameters estimating LVFP were compared among the groups.
The median LAP was 12.6 ± 5.7 mm Hg in the entire cohort. LAP was significantly higher in group E than that in the other groups (groups E vs U vs N, 14.2 ± 6.3 mm Hg vs 13.5 ± 5.9 mm Hg vs 12.0 ± 5.5 mm Hg; P < 0.001). Among group E patients, 43.1% had elevated LAP (≥15 mm Hg), whereas 56.9% had normal LAP (<15 mm Hg). Of the patients in group N, 69.0% had normal LAP, whereas 31% had elevated LAP. Although the correlation between invasively measured LAP and E/e\', peak tricuspid regurgitant velocity, and left atrial volume index was modest, the number of abnormal values correlated significantly with elevated LAP (P < 0.001).
The classification using combined echocardiographic parameters in the recommendations may be useful for detecting patients with normal LVFP but may be limited for detecting elevated LVFP.
这项研究的目的是在大规模队列中使用侵入性测量的左心房压力(LAP)研究算法分类系统的可靠性。
作者纳入了1,967名患者(年龄68±10岁),这些患者在心房颤动导管消融期间直接在左心房内测量LAP。根据超声心动图算法将患者分为3组:正常(N组,n=1,282),未确定(U组,n=160),和升高(E组,n=346)LAP组。比较各组间侵入性测量的LAP和估计LVFP的超声心动图参数。
整个队列的中位LAP为12.6±5.7mmHg。E组LAP显著高于其他组(E组、U组、N组、14.2±6.3mmHgvs13.5±5.9mmHgvs12.0±5.5mmHg;P<0.001)。在E组患者中,43.1%的人LAP升高(≥15mmHg),而56.9%的LAP正常(<15mmHg)。在N组的患者中,69.0%有正常的LAP,而31%的LAP升高。尽管侵入性测量的LAP和E/E'之间的相关性,三尖瓣反流速度峰值,左心房容积指数适中,异常值的数量与LAP升高显著相关(P<0.001)。
建议中使用联合超声心动图参数的分类可能对检测LVFP正常的患者有用,但对检测LVFP升高可能有限。