Abstract：
Although estimation of left ventricular filling pressure (LVFP) using an integrated echocardiographic algorithm is recommended, the usefulness of this algorithm has not been fully validated.
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.
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.
摘要：
尽管建议使用综合超声心动图算法估计左心室充盈压(LVFP),该算法的有用性尚未得到充分验证。
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。
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。
