METHODS: In 193 patients with cardiovascular diseases who underwent cardiac catheterization within 2 d of echocardiography, the hepatic vein systolic filling fraction (HV-SFF) and the ratio of the peak systolic to diastolic forward velocities of the SVC (SVC-S/D) were measured. HV-SFF < 55% and SVC-S/D < 1.9 were regarded as elevated RAP. We also calculated the fibrosis 4 index (FIB-4) as a serum liver fibrosis marker.
RESULTS: HV-SFF and SVC-S/D were feasible in 177 (92%) and 173 (90%) patients, respectively. In the 161 patients in whom both venous Doppler waveforms could be measured, HV-SFF and SVC-S/D were inversely correlated with RAP (r = -0.350, p < 0.001; r = -0.430, p < 0.001, respectively). SVC-S/D > 1.9 showed a significantly higher diagnostic accuracy of RAP elevation compared with HV-SFF < 55% (area under the curve, 0.842 vs. 0.614, p < 0.001). Multivariate analyses showed that both FIB-4 (β = -0.211, p = 0.013) and mean RAP (β = -0.319, p < 0.001) were independent determinants of HV-SFF. In contrast, not FIB-4 but mean RAP (β = -0.471, p < 0.001) was an independent determinant of SVC-S/D. The diagnostic accuracy remained unchanged when HV-SFF < 55% was considered in conjunction with the estimated RAP based on the inferior vena cava morphology. Conversely, SVC-S/D showed an incremental diagnostic value over the estimated RAP.
CONCLUSIONS: SVC-S/D enabled a more accurate diagnosis of RAP elevation than HV-SFF.
方法:在超声心动图检查2d内行心导管检查的193例心血管疾病患者中,测量了肝静脉收缩期充盈分数(HV-SFF)和SVC的收缩期峰值与舒张期前向速度之比(SVC-S/D)。HV-SFF<55%和SVC-S/D<1.9被认为是升高的RAP。我们还计算了纤维化4指数(FIB-4)作为血清肝纤维化标志物。
结果:HV-SFF和SVC-S/D在177(92%)和173(90%)患者中可行,分别。在161名患者中,可以测量两个静脉多普勒波形,HV-SFF和SVC-S/D与RAP呈负相关(r=-0.350,p<0.001;r=-0.430,p<0.001)。SVC-S/D>1.9显示,与HV-SFF<55%相比,RAP升高的诊断准确性显着提高(曲线下面积,0.842vs.0.614,p<0.001)。多变量分析表明,FIB-4(β=-0.211,p=0.013)和平均RAP(β=-0.319,p<0.001)是HV-SFF的独立决定因素。相比之下,不是FIB-4,而是平均RAP(β=-0.471,p<0.001)是SVC-S/D的独立决定因素。当HV-SFF<55%与基于下腔静脉形态的估计RAP一起考虑时,诊断准确性保持不变。相反,SVC-S/D显示出比估计的RAP增加的诊断价值。
结论:SVC-S/D能够比HV-SFF更准确地诊断RAP升高。