保存されたエジェクション分数による心臓不全の診断に役立つ,シンプルで,証拠に基づいたアプローチ
Yogesh N V Reddy1, Rickey E Carter2, Masaru Obokata1
1Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (Y.N.V.R., M.O., M.M.R., B.A.B.).
Circulation
|May 25, 2018
まとめ
新しいH2FPEFスコアは,呼吸不全の患者の心不全の診断に役立ちます. このスコアは,診断の正確性を向上させ,さらなる検査を導くために,臨床的要因とエコーカーディオグラフィを使用します.
科学分野:
- 心臓病科
- 診断医学
- 医学 研究
背景:
- 呼吸不全を呈するエボレミア患者において,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臨床的に困難です.
- 現在,この患者集団におけるHFpEFの診断基準は存在しない.
- この研究は,原因不明の呼吸不全の患者におけるHFpEFの確率を推定するための非侵襲的基準を開発し,検証することを目的とした.
研究 の 目的:
- 保存されたエジェクション分数 (HFpEF) による心不全の診断のための新しい非侵襲的なスコアシステムを開発し,検証する.
- 未解明の呼吸不全でHFpEFを患っている患者を特定し,その後の診断評価を導くために臨床医を支援する.
- 既存の方法と比較してHFpEFの診断精度を向上させる.
主な方法:
- 原因不明の呼吸不全の連続した患者を遡及的に評価し,侵襲的な血液動力学的運動検査に推薦した.
- HFpEFと非心臓呼吸不全の診断は,侵襲的な血液動力学的運動検査によって確認された.
- ロジスティック回帰は,予測可能な臨床変数を特定するために使用され,H2FPEFスコアを別々のコホートで開発および検証しました.
主要な成果:
- H2FPEFスコアには,肥満,心房細動,年齢> 60,抗高血圧薬> 2,E/ e'比> 9,肺動脈静脈圧> 35mmHgが含まれています.
- このスコアは,HFpEFの強い差別力 (AUC0. 841で導出,0. 886で検証) を示した.
- H2FPEFスコアは現在の専門家によるコンセンサスアルゴリズムを大幅に上回った.
結論:
- H2FPEFスコアは,単純な臨床およびエコーカルディオグラフィのデータを使用して,HFpEFと非心臓呼吸不全を効果的に区別します.
- このスコアは,原因不明の運動呼吸不全の患者のさらなる診断の必要性を判断するのに役立ちます.
- H2FPEFスコアは,HFpEF診断を改善するための実用的なツールです.
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