Background

Recent American Society of Echocardiography (ASE)/European Association of Cardiovascular Imaging (EACVI) guidelines for echocardiographic evaluation of left ventricular (LV) diastolic function provide a practical, simplified diagnostic algorithm for estimating LV filling pressure. The aim of this study was to test the accuracy of this algorithm against invasively measured pressures and compare it with the accuracy of the previous 2009 guidelines in the same patient cohort.

Methods

Ninety patients underwent transthoracic echocardiography immediately before left heart catheterization. Mitral inflow E/A ratio, E/e′, tricuspid regurgitation velocity, and left atrial volume index were used to estimate LV filling pressure as normal or elevated using the ASE/EACVI algorithm. Invasive LV pre-A pressure was used as a reference, with >12 mm Hg defined as elevated.

Results

Invasive LV pre-A pressure was elevated in 40 (44%) and normal in 50 (56%) patients. The 2016 algorithm resulted in classification of 9 of 90 patients (10%) as indeterminate but estimated LV filling pressures in agreement with the invasive reference in 61 of 81 patients (75%), with sensitivity of 0.69 and specificity of 0.81. The 2009 algorithm could not definitively classify 4 of 90 patients (4.4%), but estimated LV filling pressures in agreement with the invasive reference in 64 of 86 patients (74%), with sensitivity of 0.79 and specificity of 0.70.

Conclusions

The 2016 ASE/EACVI guidelines for estimation of filling pressures are more user friendly and efficient than the 2009 guidelines and provide accurate estimates of LV filling pressure in the majority of patients when compared with invasive measurements. The simplicity of the new algorithm did not compromise its accuracy and is likely to encourage its incorporation into clinical decision making.

中文翻译：

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超声心动图评估左心室充盈压使用2016年舒张期指南：与2009年指南的头对头比较

背景

最近的美国超声心动图学会（ASE）/欧洲心血管成像协会（EACVI）对左心室（LV）舒张功能进行超声心动图评估的指南提供了一种实用的，简化的诊断算法，用于估计LV充盈压。这项研究的目的是针对有创测量的压力测试该算法的准确性，并将其与同一患者队列中的2009年以前指南的准确性进行比较。

方法

90例患者在左心导管插入术前立即接受了胸腔超声心动图检查。使用ASE / EACVI算法，使用二尖瓣流入E / A比，E / e'，三尖瓣关闭不全速度和左心房容积指数来估计左室充盈压正常或升高。LV前A的有创压力用作参考，> 12 mm Hg定义为升高。

结果

40名患者（44％）的LV前A压升高，而50名患者（56％）的LV压力升高为正常。2016年算法将90例患者中的9例（10％）分类为不确定但估计的LV充盈压，与81例患者中61例（75％）的侵入参考相符，敏感性为0.69，特异性为0.81。2009年的算法无法对90例患者中的4例（4.4％）进行明确分类，但估计左室充盈压与86例患者中64例（74％）的侵入参考相符，敏感性为0.79，特异性为0.70。

结论

与有创测量相比，2016年ASE / EACVI估计充盈压指南比2009年指南更加用户友好和高效，并且可以为大多数患者提供准确的LV充盈压估算。新算法的简单性不会影响其准确性，并且很可能会鼓励将其纳入临床决策。