■评估充盈压力(FP)仍然是一个临床挑战,尽管在非侵入性成像技术的进步。这项研究调查了超声心动图左心室(LV)与左心房(LA)体积比在估计呼吸困难和射血分数(EF)保留的患者的静息FP中的实用性。
■这项研究是一项前瞻性研究,单中心分析53例连续呼吸困难(纽约心脏协会2级或3级)且LVEF≥50%(平均年龄71±10岁)接受心导管插入术的患者,包括使用逆行技术直接测量静止时的左心房压力。心脏导管插入后1.5±1.0h获得超声心动图数据。患者分为两组:第1组由FP升高的个体组成,平均LA压或平均肺毛细血管楔压>12mmHg,第2组由FP正常的患者组成。在三个特定点测量LV和LA体积:最小体积(LVES,LAmin),舒张期间的体积(LVdias,LAdias),和最大音量(LVED,LAmax)。分析了相应的LV/LA体积比:收缩末期(LVES/LAmax),舒张(LVdias/LAdias),和舒张末期(LVED/LAmin)。
■与第2组相比,第1组患者的LV/LA体积比降低(LVES/LAmax0.44±0.12vs.0.60±0.23,P=0.0032;LVdias/LAdias1.13±0.30vs.1.56±0.49,P=0.0007;LVED/LAmin2.71±1.57vs.4.44±1.70,P=0.0004)。LV/LA体积比与FP增加成反比(LVES/LAmax,r=-0.40,P=0.0033;LVdias/LAdias,r=-0.45,P=0.0007;LVED/LAmin,r=-0.55,P<0.0001)。在所有的测量中,LVdias/LAdias比值显示出最高的区分FP升高患者和正常FP的能力,整个组的截断值≤1.24[曲线下面积(AUC)=0.822],包括窦性心律和心房颤动。特别是对于窦性心律的患者,截止值≤1.28(AUC=0.799),两者的P<0.0001。LVdias/LAdias指数显示出对E/e'比率的非劣效性[ΔAUC=0.159,置信区间(CI)=-0.020-0.338;P=0.0809],在超越LA储层功能指数(ΔAUC=0.249,CI=0.044-0.454;P=0.0176)的同时,LA储层应变(ΔAUC=0.333,CI=0.149-0.517;P=0.0004),和LAmax指数(ΔAUC=0.224,CI=0.043-0.406;P=0.0152)在诊断FP升高患者中的作用。
■该研究提出了一种简单且可重复的方法,用于在呼吸困难和EF保留的患者中使用常规TTE进行FP的非侵入性评估。LVdias/LAdias指数是一个有希望的指标,用于识别高FP,表现出与既定参数相当甚至更优越的性能。
UNASSIGNED: Assessing filling pressure (FP) remains a clinical challenge despite advancements in non-invasive imaging techniques. This study investigates the utility of echocardiographic left ventricular (LV) to left atrial (LA) volume ratio in estimating the resting FP in patients with dyspnoea and preserved ejection fraction (EF).
UNASSIGNED: This study is a prospective, single-centre analysis of 53 consecutive patients with dyspnoea (New York Heart Association grade 2 or 3) and LVEF of ≥50% (mean age 71 ± 10 years) who underwent cardiac catheterisation, including direct measurement of LA pressure at rest using retrograde technique. Echocardiographic data were obtained 1.5 ± 1.0 h after cardiac catheterisation. The patients were divided into two groups: Group 1 consisted of individuals with elevated FP, indicated by a mean LA pressure or mean pulmonary capillary wedge pressure of >12 mmHg, and Group 2 comprised of patients with normal FP. The LV and LA volumes were measured at three specific points: the minimum volume (LVES, LAmin), the volume during diastasis (LVdias, LAdias), and the maximum volume (LVED, LAmax). The corresponding LV/LA volume ratios were analysed: end-systole (LVES/LAmax), diastasis (LVdias/LAdias), and end-diastole (LVED/LAmin).
UNASSIGNED: The patients in Group 1 exhibited lower LV/LA volume ratios compared with those in Group 2 (LVES/LAmax 0.44 ± 0.12 vs. 0.60 ± 0.23, P = 0.0032; LVdias/LAdias 1.13 ± 0.30 vs. 1.56 ± 0.49, P = 0.0007; LVED/LAmin 2.71 ± 1.57 vs. 4.44 ± 1.70, P = 0.0004). The LV/LA volume ratios correlated inversely with an increased FP (LVES/LAmax, r = -0.40, P = 0.0033; LVdias/LAdias, r = -0.45, P = 0.0007; LVED/LAmin, r = -0.55, P < 0.0001). Among all the measurements, the LVdias/LAdias ratio demonstrated the highest discriminatory power to distinguish patients with elevated FP from normal FP, with a cut-off value of ≤1.24 [area under the curve (AUC) = 0.822] for the entire group, encompassing both sinus rhythm and atrial fibrillation. For patients in sinus rhythm specifically, the cut-off value was ≤1.28 (AUC = 0.799), with P < 0.0001 for both. The LVdias/LAdias index demonstrated non-inferiority to the E/e\' ratio [ΔAUC = 0.159, confidence interval (CI) = -0.020-0.338; P = 0.0809], while surpassing the indices of LA reservoir function (ΔAUC = 0.249, CI = 0.044-0.454; P = 0.0176), LA reservoir strain (ΔAUC = 0.333, CI = 0.149-0.517; P = 0.0004), and LAmax index (ΔAUC = 0.224, CI = 0.043-0.406; P = 0.0152) in diagnosing patients with elevated FP.
UNASSIGNED: The study presents a straightforward and reproducible method for non-invasive estimation of FP using routine TTE in patients with dyspnoea and preserved EF. The LVdias/LAdias index emerges as a promising indicator for identifying elevated FP, demonstrating comparable or even superior performance to established parameters.