背景:为了探索如何准确定量地测量LAPEq,也就是说,使用二尖瓣反流频谱通过方程法测量和计算左心房压力(LAP)。
方法:二尖瓣反流频谱,同时采集28例患者的肺动脉楔压(PAWP)和桡动脉有创动脉收缩压,包括3名风湿性心脏病患者,15例二尖瓣脱垂和10例冠状动脉旁路移植术,中度或以上主动脉瓣狭窄患者被排除.LAPBp(多普勒血压计法),LAPEq(方程法)和LAPC(导管法)同步测量,并对三种方法的测量结果进行了对比分析。自行设计了一种特殊的智能多普勒频谱分析软件,以精确测量LAPEq。这项研究已获得北部战区总医院伦理委员会的批准(K-2019-17),并申请临床试验(编号:Chictr190023812)。
结果:发现LAPC和LAPEq的测量结果之间没有显着统计学差异(t=0.954,P=0.348),两种方法之间的显著相关性[r=0.908(0.844,0.964),P<0.001]。尽管LAPC和LAPBP的测量结果在非重度偏心性二尖瓣反流的情况下是一致的,两种方法在总体情况下存在显著差异,相关性弱[r=0.210,(-0.101,0.510),P=0.090]。在P1或P3脱垂的MVP患者中,由于MR的严重偏心,MR的峰值压差被低估,影响了LAPBP测量的精度。
结论:研究表明,LAPEq和LAPC之间存在良好的相关性,验证了基于二尖瓣反流频谱的左心房压力无创直接定量测量是可行的,具有良好的应用前景。
BACKGROUND: To explore how to measure LAPEq accurately and quantitatively, that is, the left atrial pressure (LAP) measured and calculated by equation method using mitral regurgitation spectrum.
METHODS: The mitral regurgitation spectrum, pulmonary arteriolar wedge pressure (PAWP) and invasive arterial systolic pressure of radial artery of 28 patients were collected simultaneously, including 3 patients with rheumatic heart disease, 15 patients with mitral valve prolapse and 10 patients with coronary artery bypass grafting, patients with moderate or above aortic stenosis were excluded. LAPBp (Doppler sphygmomanometer method), LAPEq (Equation method) and LAPC (Catheter method) were measured synchronously, and the measurement results of the three methods were compared and analyzed. A special intelligent Doppler spectrum analysis software was self-designed to accurately measure LAPEq. This
study had been approved by the ethics committee of the Northern Theater General Hospital (K-2019-17), and applied for clinical
trial (No. Chictr 190023812).
RESULTS: It was found that there was no significant statistical difference between the measurement results of LAPC and LAPEq (t = 0.954, P = 0.348), and significant correlation between the two methods [r = 0.908(0.844, 0.964), P < 0.001]. Although the measurement results of LAPC and LAPBP are consistent in the condition of non-severe eccentric mitral regurgitation, there are significant differences in the overall case and weak correlation between the two methods [r = 0.210, (-0.101, 0.510), P = 0.090]. In MVP patients with P1 or P3 prolapse, the peak pressure difference of MR was underestimated due to the serious eccentricity of MR, which affected the accuracy of LAPBP measurement.
CONCLUSIONS: It was shown that there is a good correlation between LAPEq and LAPC, which verifies that the non-invasive and direct quantitative measurement of left atrial pressure based on mitral regurgitation spectrum is feasible and has a good application prospect.