不同左心室舒张末压慢性射血分数保留性心力衰竭患者超声心动图参数差异分析-《中国医学物理学杂志》

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Title:: Differences of echocardiographic parameters in patients with chronic heart failure and preserved ejection fraction under different left ventricular end-diastolic pressures

文章编号:: 1005-202X（2021）05-0596-06

作者:: 蒋殿虎1; 陈志旺2; 白书昌3; 毛羡仪1; 赖菊霞1; 夏张青3; 陈普文3; 1.佛山市第二人民医院超声医学科，广东佛山 528000； 2.贵溪市中医院超声科，江西贵溪 335400； 3.佛山市第二人民医院心内科，广东佛山 528000

Author(s):: JIANG Dianhu1; CHEN Zhiwang2; BAI Shuchang3; MAO Xianyi1; LAI Juxia1; XIA Zhangqing3; CHEN Puwen3; 1. Department of Medical Ultrasound, the Second Peoples Hospital of Foshan City, Foshan 528000, China 2. Department of Ultrasound, Traditional Chinese Medicine Hospital of Guixi City, Guixi 335400, China 3. Department of Cardiology, the Second Peoples Hospital of Foshan City, Foshan 528000, China

关键词:: 左心室舒张末压; 慢性射血分数保留性心力衰竭; 超声心动图

Keywords:: Keywords: left ventricular end-diastolic pressure chronic heart failure with preserved ejection fraction echocardiography

分类号:: R445.1

DOI:: DOI:10.3969/j.issn.1005-202X.2021.05.014

文献标志码:: A

摘要:: 目的：研究不同左心室舒张末压（LVEDP）慢性射血分数保留性心力衰竭（HFpEF）患者超声心动图参数变化情况，进一步探讨不同测量方法预测LVEDP升高的效能。方法：纳入2018年7月至2020年4月收治的96例HFpEF患者为研究对象，均接受左心导管检查，于舒张末期测量LVEDP。按照LVEDP实时测值，将入选患者分为A组（35例，LVEDP正常，实时测值≤15 mmHg）和B组（61例，LVEDP升高，实时测值>15 mmHg）。比较两组超声心动图参数差异，包括左心室射血分数（LVEF）、左心房容积指数（LAVI）、三尖瓣反流最大流速（TRmax）、二尖瓣口舒张早期血流速度（E）/二尖瓣口舒张晚期血流速度（A）、E峰减速时间（DT）、A峰持续时间（A-dur）、肺静脉收缩期S波流速（PVs）、舒张早期D波流速（PVd）、PVs/PVd、心房收缩期肺静脉逆向A波流速（PVa）、心房收缩期肺静脉逆向A波血流时间（Pva-dur）、心房收缩期肺静脉逆向血流时间与二尖瓣心房收缩期血流时间的差值（PvaD-AD）、二尖瓣环舒张早期平均运动速度（e）、二尖瓣环侧壁舒张早期运动速度（elat）、二尖瓣环间隔处舒张早期运动速度（esep）、E/e、E/elat、E/esep。将超声心动图中有统计学意义的参数按测量方法的不同分为LAVI、频谱多普勒相关参数（TRmax、PVa、Pva-dur、PvaD-AD）及组织多普勒相关参数（e、elat、esep、E/e、E/elat、E/esep）3个组。采用受试者工作特性曲线（ROC）对比分析这3组参数独立预测LVEDP升高的效能，且进一步对比分析LAVI联合频谱多普勒相关参数及LAVI联合频谱多普勒相关参数预测LVEDP升高的敏感度和特异度。结果：A组LAVI、TRmax、PVa、Pva-dur、PvaD-AD、E/e、E/elat、E/esep显著低于B组（P<0.05），e、elat、esep显著高于B组（P<0.05），LVEF、E/A、DT、A-dur、PVs、PVd、PVs/PVd与B组比较差异均无统计学意义（P>0.05）。经ROC曲线分析，预测LVEDP升高的效能最高的是频谱多普勒相关参数（TRmax、PVa、Pva-dur、PvaD-AD）诊断，其次是组织多普勒相关参数（e、elat、esep、E/e、E/elat、E/esep），最后是LAVI。对比LAVI与频谱多普勒各参数联合诊断及LAVI与组织多普勒各参数联合诊断，以LAVI与频谱多普勒各参数联合诊断LVEDP升高的效能更高。结论：超声心动图多参数的综合应用对HFpEF患者LVEDP升高具有一定预测效能。

Abstract:: Abstract: Objective To study the changes of echocardiographic parameters in patients with chronic heart failure and preserved ejection fraction (HFpEF) under different left ventricular end-diastolic pressures (LVEDP), and to further explore the efficiency of different measurement methods in predicting LVEDP increase. Methods A total of 96 HFpEF patients admitted to hospital from July 2018 to April 2020 were enrolled in the study. All patients underwent left heart catheterization, and their LVEDP was measured at the end of diastole. According to LVEDP real-time measurements, the selected patients were divided into group A (35 cases, normal LVEDP, real-time measurements ≤15 mmHg) and group B (61 cases, increased LVEDP, real-time measurements >15 mmHg). The differences in echocardiographic parameters between two groups were compared. The echocardiographic parameters discussed in the study included left ventricular ejection fraction (LVEF), left atrial volume index (LAVI), the maximum velocity of tricuspid regurgitation (TRmax), the early diastolic blood flow velocity of mitral valve orifice (E)/the late diastolic blood flow velocity of mitral valve orifice (A), the deceleration time of peak E (DT), the duration of peak A (A-dur), pulmonary vein systolic S-wave velocity (PVs), early diastolic D-wave velocity (PVd), PVs/PVd, atrial systolic pulmonary vein retrograde A-wave velocity (PVa), the duration of atrial systolic pulmonary vein retrograde A-wave blood flow (PVa-dur), difference between the duration of atrial systolic pulmonary vein retrograde blood flow and the duration of mitral valve atrial systolic blood flow (PvaD-AD), the early diastolic average velocity of mitral valve ring (e), the early diastolic velocity of mitral valve ring side wall (elat), the early diastolic velocity of mitral valve ring spacing (esep), E/e and E/elat, E/esep. The echocardiographic parameters with statistical significance were divided into LAVI, spectral Doppler-related parameters (TRmax, PVa, Pva-dur, PvaD-AD,) and tissue Doppler-related parameters (e, elat，esep, E/e, E/elat, E/esep) according to different measurement methods. Receiver operating characteristic curve was used to compare and analyze the efficiency of 3 groups of parameters in independently predicting LVEDP increase, and further compare and analyze the sensitivity and specificity of LAVI combined with spectral Doppler-related parameters or tissue Doppler-related parameters in predicting LVEDP increase. Results The LAVI, TRmax, PVa, Pva-dur, PvaD-AD, E/e, E/elat, E/esep in group A were significantly lower than those in group B (P<0.05), while e, elat and esep were significantly higher than those in group B (P<0.05), but no statistical difference was found in LVEF, E/A, DT, A-dur, PVs, PVd, PVs/PVd (P>0.05). The receiver operating characteristic curve analysis showed that the most effective predictor of LVEDP increase was spectrum Doppler-related parameters (TRmax, PVa, Pva-dur, PvaD-AD), followed by tissue Doppler-related parameters (e, elat, esep, E/e, E/elat, E/esep) and LAVI. The combination of LAVI and spectrum Doppler-related parameters has a higher diagnostic efficiency than LAVI combined with tissue Doppler-related parameters in predicting LVEDP increase. Conclusion The comprehensive application of echocardiographic parameters has a certain predictive effect on the increase of LVEDP.

《中国医学物理学杂志》[ISSN:1005-202X/CN:44-1351/R]

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