背景:矢量血流图(VFM)和能量损失(EL)评估是新兴的超声心动图技术,可提供对心脏功能的详细了解。本研究旨在探讨EL参数与B型利钠肽(BNP)水平的关系,心力衰竭严重程度的公认标志。
方法:我们的研究前瞻性地纳入了62例呼吸急促和疑似心力衰竭的患者,在2018年1月至2020年8月期间接受了超声心动图检查并测量了BNP水平.根据BNP水平对患者进行分层,并评估其临床和超声心动图特征。进行了单变量和多变量回归分析,以评估BNP水平与各种超声心动图变量之间的相关性。包括VFM参数。
结果:患者根据BNP水平分为两组:BNP<200pg/ml(n=53)和BNP≥200pg/ml(n=9)。BNP≥200pg/ml的患者表现出明显不同的临床和超声心动图特征,例如年龄较大,较大的左心室质量和容积指数,肺动脉收缩压较高,较高的E/E比率,和较大的EL参数。多变量回归分析显示E/e比值和ELA(心房收缩期的EL/A波比值是logBNP的重要决定因素。受试者工作特征曲线分析显示,ELA/A>36.0J/m2是高BNP的重要预测因子,其敏感性为89%,特异性为85%。ELA/A对预测高BNP的左心房压力升高具有递增的诊断价值(C统计量=0.98vs0.74,P=0.006)。
结论:这项研究为EL参数作为心脏负荷辅助指标的潜在用途提供了新的见解,从而提高我们对心力衰竭的认识。
BACKGROUND: Vector Flow Mapping (VFM) and Energy Loss (EL) evaluation are emerging echocardiographic techniques that offer detailed insights into cardiac function. This
study aimed to explore the relationship between EL parameters and B-type natriuretic peptide (BNP) levels, a well-established marker of heart failure severity.
METHODS: Our
study prospectively enrolled 62 patients experiencing shortness of breath and suspected heart failure, who underwent echocardiography and had BNP levels measured between January 2018 and August 2020. Patients were stratified based on BNP levels, and their clinical and echocardiographic characteristics were evaluated. Univariate and multivariate regression analyses were performed to assess the correlation between BNP levels and various echocardiographic variables, including VFM parameters.
RESULTS: Patients were stratified into two groups based on their BNP levels: BNP < 200 pg/ml (n = 53) and BNP ≥ 200 pg/ml (n = 9). Patients with BNP ≥ 200 pg/ml presented significantly different clinical and echocardiographic characteristics, such as older age, larger left ventricular mass and volume indices, higher pulmonary artery systolic pressure, higher E/e\' ratio, and larger EL parameters. Multivariate regression analysis demonstrated the E/e\' ratio and ELA (EL during Atrial contraction phase/A wave ratio as significant determinants of logBNP. Receiver operating characteristic curve analysis showed ELA/A > 36.0 J/m2 as a significant predictor of high BNP with 89% sensitivity and 85% specificity. ELA/A demonstrated an incremental diagnostic value over elevated left atrial pressure for predicting high BNP (C statistic = 0.98 vs 0.74, P = 0.006).
CONCLUSIONS: This
study provides novel insights into the potential utility of EL parameters as auxiliary indicators of cardiac load, thereby enhancing our understanding of heart failure.