保存されたエジェクション分数による心不全の評価におけるダイアストリックストレステストの役割:同時侵襲性エコーカルディオグラフィー研究

Masaru Obokata¹, Garvan C Kane¹, Yogesh N V Reddy¹

¹From Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic Rochester, MN (M.O., G.C.K., Y.N.V.R., T.P.O., B.A.B.); and IKEM - Institute for Clinical and Experimental Medicine, Department of Cardiology, Prague, Czech Republic (V.M.).

Circulation

|January 1, 2017

まとめ

発射分数保存 (HFpEF) による心不全の診断は難しい. 運動エコーは,HFpEFの診断の精度を改善し,感度とマイナスの予測値を高めます.

科学分野:

心臓病科
医療診断

背景:

保存されたエジェクション分数 (HFpEF) による心不全の診断は複雑で,しばしば心充填圧の上昇に依存します.
現行のガイドラインはナトリウレティックペプチドとエコーカーディオグラフィを使用していますが,支持するデータは矛盾しています.

研究の目的:

侵襲的な測定と比較して休息と運動のエコーカーディオグラフィーを用いて現在のHFpEFガイドラインの診断精度を評価する.

主な方法:

予期的な同時エコーカーディオグラフィー・キャセテリゼーション試験は,休息と運動中に実施された.
侵入的に証明されたHFpEFを持つ50人の被験者と呼吸不全の24人の対照群を対象とした.

主要な成果:

休息中のナトリウレチンペプチド濃度は,18%の症例でHFpEFを排除するのに不十分であった.
休息時のE/e'比は肺毛細血管の圧と相関する (r=0.63).
現在の休息指針では,弱い感度 (34%-60%) が示され,運動E/e'のデータを追加すると,感度が90%に改善されたが,特異性は71%に低下した.

結論:

現在の休息時の診断ガイドラインは,HFpEFに対する感度が低い.
運動エコーはHFpEFの感度と負の予測値を改善し,その状態を排除するのに役立ちます.
血液動力学的評価による運動検査は,HFpEFの診断を確認または反証するのに価値があります.

キーワード:

診断する運動する運動テスト心不全

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