扩张应激测试对心力衰竭的评估中的作用:同时进行的侵袭性心声学研究
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
概括
诊断心力衰竭与保存的喷射分数 (HFpEF) 是一个挑战. 运动心声学通过提高灵敏度和负预测值来提高诊断HFpEF的准确性.
科学领域:
- 心脏病学
- 医疗诊断
背景情况:
- 诊断心力衰竭与保留喷射分数 (HFpEF) 是复杂的,通常依赖于心脏填充压力的升高.
- 目前的指导方针使用尿和心声学,但支持数据是相互矛盾的.
研究的目的:
- 使用休息和运动心声相比侵入性测量,评估当前HFpEF指南的诊断准确性.
主要方法:
- 在休息和运动期间进行了前性同时回声心血管导管研究.
- 包括50名具有侵入性证明的HFpEF和24名呼吸障碍的对照患者.
主要成果:
- 在18%的病例中,休息的尿酸水平不足以排除HFpEF.
- 休息时E/e'比与肺毛细血管压相关 (r=0.63).
- 目前的休息指南显示灵敏度较低 (34%-60%),而添加运动E/e'数据则提高了灵敏度至90%,但降低了特异性至71%.
结论:
- 目前的休息诊断指南对HFpEF的敏感度很低.
- 运动心声学提高了HFpEF的灵敏度和负预测值,有助于排除这种情况.
- 具有血液动力学评估的运动测试对于确认或反驳HFpEF诊断是有价值的.
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