通过被动抬腿和低工作负荷运动来诊断心力衰竭的诊断性表现,使用保存的喷射分数来诊断心力衰竭
Claudia Baratto1, Samuele Minari2, Vishal N Rao3
1Department of Management, Information and Production Engineering, University of Bergamo, Dalmine BG, Italy; Department of Cardiology, Ospedale San Luca IRCCS Istituto Auxologico Italiano, Milan, Italy.
被动腿部提升 (PLR) 和低工作负载运动测试可以帮助诊断心力衰竭与保存的喷射分数 (HFpEF). 虽然这些挑性测试对于确认HFpEF有用,但对于排除这种情况来说效果不那么好.
科学领域:
- 心脏病学 心脏病学
- 心血管生理学心血管生理学
- 诊断医学 诊断医学
背景情况:
- 在右心导管术 (RHC) 期间的挑性测试可以揭示隐性心力衰竭与保存的喷射分数 (HFpEF).
- 肺动脉压 (PAWP) 是诊断HFpEF的一个关键血液动力学参数.
研究的目的:
- 为了评估PAWP在被动抬腿 (PLR) 和低工作负荷卧底运动 (EX1) 中的诊断性能,用于诊断HFpEF.
- 为了比较PLR和EX1在裁决或排除HFpEF中的有效性.
主要方法:
- 一项2个中心的国际队列研究,涉及166名患有不明原因呼吸障碍和休息时PAWP≤15mmHg的患者.
- 患者在PLR (PAWP_PLR) 和低工作负荷运动 (PAWP_EX1) 期间进行了PAWP测量,并进行了症状有限的运动卧底RHC.
主要成果:
- 与PAWP_PLR (AUC 0.67) 相比,PAWP_EX1显示出更高的诊断性能 (AUC 0.85).
- PAWP_PLR < 4 mmHg 肯定排除了 HFpEF;PAWP_PLR ≥ 19-21 mmHg 对 HFpEF 的特异性很高.
- PAWP_EX1 <9 mmHg排除了HFpEF,具有100%的灵敏度;PAWP_EX1 >25 mmHg对HFpEF具有100%的特异性.
结论:
- 无论是PLR还是低工作负载的仰卧运动都能缩小HFpEF的诊断不确定性.
- 这些挑性的机动更有效地支配了,而不是排除了HFpEF.
- 与PAWP_PLR相比,PAWP_EX1显示出HFpEF诊断的更大潜力.
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