在心力衰竭的诊断中存在差异,在仰卧与直立运动之间保留了喷射分数,对血动力学测试进行了直立运动
Marat Fudim1,2,3, Veraprapas Kittipibul1,2, Ashley Swavely1
1Department of Medicine (M.F., V.K., A.S., A.G., J. Mikitka, E.Y., O.D., M.R., J.F., J. Molinger, B.P.), Duke University Medical Center, Durham, NC.
一半被诊断为患有心力衰竭的患者,使用卧卧运动右心脏导管,在直立姿势下测试时不符合标准. 这种不和的HFpEF组显示出较少的异常,表明位置差异对诊断有影响.
科学领域:
- 心脏病学 心脏病学
- 运动生理学 运动生理学
- 诊断成像 诊断成像 诊断成像
背景情况:
- 侵袭性炼右心导管是诊断心力衰竭与保留射出小部分 (HFpEF) 的黄金标准.
- 在此测试期间的血液动力学测量可能会受到患者的位置的影响 (仰卧或直立).
- 基于运动测试期间身体位置的HFpEF诊断差异仍然不清楚.
研究的目的:
- 通过使用右心导管检查,调查卧卧和直立运动测试之间的HFpEF诊断差异.
- 为了确定与不一致的HFpEF诊断相关的患者特征.
主要方法:
- 一项两中心前性研究招募了通过运动右心导管导管诊断HFpEF诊断的患者.
- 使用了一种新的"直立"协议,结合了下最大的仰卧和最大的直立自行车人体工程学.
- 针对每个位置的血液动力学标准用于诊断HFpEF,将患者分类为一致或不一致.
主要成果:
- 50%的患者 (18/36) 在仰卧姿势中符合HFpEF标准,在直立姿势中不符合这些标准 (不一致的HFpEF).
- 不一致的HFpEF患者表现出较少的心房动,较低的左心房体积和较低的H2FPEF得分.
- 不一致的HFpEF患者在休息状态下显著降低肺动脉压,并在直立状态下达到峰值运动,以及较低的肺动脉压/心脏输出斜率.
结论:
- 显著比例的HFpEF诊断是位置依赖的,50%的卧卧诊断的患者在直立时不符合标准.
- 患有不一致的HFpEF患者表现出较少的结构和血液动力学异常,这表明诊断标准上的位置影响.
- "直立"方案是可行的,需要进一步的研究来澄清不一致的运动血液动力学发现的临床意义.
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