背景:近年来,射血分数保留的心力衰竭(HFpEF)已受到越来越多的临床关注。探讨平面门控血池成像(MUGA)的舒张功能参数对冠状动脉粥样硬化性心脏病(冠心病,CAD)患者。
方法:97例左心室射血分数≥50%的冠心病患者纳入研究。基于左心室舒张末期压(LVEDP),将患者分为HFpEF组(LVEDP≥16mmHg,47例)和LV舒张功能正常组(LVEDP<16mmHg,50例)。通过平面MUGA获得的舒张功能参数包括峰值填充率(PFR),舒张期的前三分之一(1/3FF)的填充分数,舒张期的前三分之一的充盈率(1/3FR),舒张期平均充盈率(MFR),和峰值填充时间(TPF)。超声心动图参数包括左心房容积指数(LAVI),三尖瓣反流峰值速度(TR峰值速度),经二尖瓣舒张早期峰值血流速度(E),二尖瓣环的平均早期舒张速度(平均e'),平均E/E比率。将平面MUGA获得的舒张功能参数与超声心动图获得的舒张功能参数进行比较,以探讨平面MUGA检测HFpEF的临床价值。
结果:从平面MUGA和超声心动图检测HFpEF获得的舒张功能参数的接收器工作特征曲线分析表明:在平面MUGA检查的参数中,PFR的曲线下面积(AUC),1/3FF,1/3FR,MFR和TPF分别为0.827、0.662、0.653、0.663和0.809。在超声心动图参数中,平均e'的AUC,平均E/E比率,峰值TR速度,LAVI值分别为0.747、0.706、0.735和0.633。PFR和TPF的组合显示0.856的AUC。PFR结合TPF值显示出比平均e'更好的预测价值(Z=2.020,P=0.043)。
结论:通过平面MUGA获得的舒张功能参数可用于诊断CAD患者的HFpEF。PFR联合TPF优于超声心动图获得的参数,对检测HFpEF具有良好的敏感性和预测能力。
In recent years, heart failure with preserved ejection fraction (HFpEF) has received increasing clinical attention. To investigate the diagnostic value of diastolic function parameters derived from planar gated blood-pool imaging (MUGA) for detecting HFpEF in coronary atherosclerotic heart disease (coronary artery disease, CAD) patients.
Ninety-seven CAD patients with left ventricular ejection fraction ≥ 50% were included in the study. Based on the left ventricular end-diastolic pressure (LVEDP), the patients were divided into the HFpEF group (LVEDP ≥ 16 mmHg, 47 cases) and the normal LV diastolic function group (LVEDP < 16 mmHg, 50 cases). Diastolic function parameters obtained by planar MUGA include peak filling rate (PFR), filling fraction during the first third of diastole (1/3FF), filling rate during the first third of diastole (1/3FR), mean filling rate during diastole (MFR), and peak filling time (TPF). Echocardiographic parameters include left atrial volume index (LAVI), peak tricuspid regurgitation velocity (peak TR velocity), transmitral diastolic early peak inflow velocity (E), average early diastolic velocities of mitral annulars (average e\'), average E/e\' ratio. The diastolic function parameters obtained by planar MUGA were compared with those obtained by echocardiography to explore the clinical value of planar MUGA for detecting HFpEF.
The Receiver-operating characteristic curve analysis of diastolic function parameters obtained from planar MUGA and echocardiography to detect HFpEF showed that: among the parameters examined by planar MUGA, the area under the curve (AUC) of PFR, 1/3FF, 1/3FR, MFR and TPF were 0.827, 0.662, 0.653, 0.663 and 0.809, respectively. Among the echocardiographic parameters, the AUCs for average e\', average E/e\' ratio, peak TR velocity, and LAVI values were 0.747, 0.706, 0.735, and 0.633. The combination of PFR and TPF showed an AUC of 0.856. PFR combined with TPF value demonstrated better predictive value than average e\' (Z = 2.020, P = 0.043).
Diastolic function parameters obtained by planar MUGA can be used to diagnose HFpEF in CAD patients. PFR combined with TPF was superior to the parameters obtained by echocardiography and showed good sensitivity and predictive power for detecting HFpEF.