Diagnostic Accuracy of the 2016 Guideline-Based Echocardiographic Algorithm to Estimate Invasively-Measured Left Atrial Pressure by Direct Atrial Cannulation,JACC: Cardiovascular Imaging

当前位置： X-MOL 学术 › JACC Cardiovasc. Imaging › 论文详情

Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)

Diagnostic Accuracy of the 2016 Guideline-Based Echocardiographic Algorithm to Estimate Invasively-Measured Left Atrial Pressure by Direct Atrial Cannulation
JACC: Cardiovascular Imaging ( IF 12.8 ) Pub Date : 2022-06-15 , DOI: 10.1016/j.jcmg.2022.03.022
Misun Pak ₁ , Takeshi Kitai ₂ , Atsushi Kobori ₁ , Yasuhiro Sasaki ₁ , Taiji Okada ₁ , Ryosuke Murai ₁ , Toshiaki Toyota ₁ , Kitae Kim ₁ , Natsuhiko Ehara ₁ , Makoto Kinoshita ₁ , Yutaka Furukawa ₁

Affiliation

Background

Although estimation of left ventricular filling pressure (LVFP) using an integrated echocardiographic algorithm is recommended, the usefulness of this algorithm has not been fully validated.

Objectives

The purpose of this study was to investigate the reliability of an algorithmic classification system using invasively measured left atrial pressure (LAP) in a large-scale cohort.

Methods

The authors enrolled 1,967 patients (age 68 ± 10 years) whose LAP was directly measured within the left atrium during catheter ablation for atrial fibrillation. Patients were classified into 3 groups based on the echocardiographic algorithm: normal (group N, n = 1,282), undetermined (group U, n = 160), and elevated (group E, n = 346) LAP groups. Invasively measured LAP and echocardiographic parameters estimating LVFP were compared among the groups.

Results

The median LAP was 12.6 ± 5.7 mm Hg in the entire cohort. LAP was significantly higher in group E than that in the other groups (groups E vs U vs N, 14.2 ± 6.3 mm Hg vs 13.5 ± 5.9 mm Hg vs 12.0 ± 5.5 mm Hg; P < 0.001). Among group E patients, 43.1% had elevated LAP (≥15 mm Hg), whereas 56.9% had normal LAP (<15 mm Hg). Of the patients in group N, 69.0% had normal LAP, whereas 31% had elevated LAP. Although the correlation between invasively measured LAP and E/e′, peak tricuspid regurgitant velocity, and left atrial volume index was modest, the number of abnormal values correlated significantly with elevated LAP (P < 0.001).

Conclusions

The classification using combined echocardiographic parameters in the recommendations may be useful for detecting patients with normal LVFP but may be limited for detecting elevated LVFP.

中文翻译：

2016 年基于指南的超声心动图算法通过直接心房插管估计侵入性测量的左心房压力的诊断准确性

背景

虽然推荐使用集成超声心动图算法估计左心室充盈压 (LVFP)，但该算法的实用性尚未得到充分验证。

目标

本研究的目的是调查在大规模队列中使用侵入性测量的左心房压力 (LAP) 的算法分类系统的可靠性。

方法

作者招募了 1,967 名患者（年龄 68 ± 10 岁），他们在导管消融治疗心房颤动期间在左心房内直接测量了 LAP。根据超声心动图算法将患者分为 3 组：正常（N 组，n = 1,282）、未确定（U 组，n = 160）和升高（E 组，n = 346）LAP 组。在各组之间比较了侵入性测量的 LAP 和估计 LVFP 的超声心动图参数。

结果

整个队列中的中位 LAP 为 12.6 ± 5.7 mm Hg。E 组的 LAP 明显高于其他组（E 组 vs U vs N，14.2 ± 6.3 mm Hg vs 13.5 ± 5.9 mm Hg vs 12.0 ± 5.5 mm Hg；P < 0.001）。在 E 组患者中，43.1% 的 LAP 升高（≥15 mm Hg），而 56.9% 的 LAP 正常（<15 mm Hg）。在 N 组患者中，69.0% 的 LAP 正常，而 31% 的 LAP 升高。尽管有创测量的 LAP 与 E/e'、三尖瓣峰值返流速度和左心房容积指数之间的相关性不大，但异常值的数量与升高的 LAP 显着相关（P < 0.001）。