BACKGROUND Doppler echocardiography, including the ratio of transmitral E to tissue Doppler e' velocities (E/e'), is widely used to estimate mean left atrial pressure (mLAP). This method, however, has not been validated in patients with acute coronary syndromes. METHODS Fifty-seven patients with acute coronary syndromes who underwent left heart catheterization and transthoracic echocardiography within 8 hours of each other were retrospectively analyzed. Forty-two of the patients (74%) were men, with a mean age of 65 ± 11 years. Patients with known cardiomyopathy, atrial fibrillation, or left-sided valvular disease were excluded. Doppler mLAP was estimated using Nagueh's formula (1.24 × [E/e'] + 1.9). Invasive mLAP was estimated using the formula of Yamamoto et al. (1.20 × mean left ventricular diastolic pressure - 0.82), wherein we averaged left ventricular diastolic pressure starting from the isovolumic relaxation phase to the post-A inflection point. Subanalyses were performed in groups with reduced or normal left ventricular ejection fraction (EF). RESULTS There was stronger agreement between the two techniques to estimate mLAP in the reduced EF group (r = 0.73, r2 = 0.53, P < .001) compared with the normal EF group (r = 0.33, r2 = 0.11, P = .08). The κ statistic for agreement was 0.34 for the overall study cohort, suggesting fair agreement according to partition values of mean mLAP: <8, 8 to 15, and >15 mm Hg. Left atrial volume index did not correlate with invasively estimated mLAP in this cohort. CONCLUSIONS In patients with acute coronary syndromes, Doppler- and catheter-derived estimates of mLAP correlate well in patients with reduced EFs. In the acute setting, echocardiographic evaluation is a reliable adjunct to clinical examination in assessment of heart failure in this subgroup of patients.

中文翻译：

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急性冠脉综合征患者平均左心房压力的估计：一项多普勒超声心动图和心脏导管研究。

背景技术多普勒超声心动图，包括透射E与组织多普勒e'速度的比率（E / e'），被广泛用于估计平均左心房压（mLAP）。但是，这种方法尚未在患有急性冠脉综合征的患者中得到验证。方法回顾性分析57例急性冠脉综合征患者，他们在8小时内进行了左心导管检查和经胸超声心动图检查。患者中有四十二名（74％）是男性，平均年龄为65±11岁。排除患有已知心肌病，房颤或左侧瓣膜病的患者。使用Nagueh公式（1.24×[E / e'] + 1.9）估算多普勒mLAP。使用Yamamoto等人的公式估算有创的mLAP。（1.20×平均左心室舒张压-0.82），其中我们从等容松弛阶段到A后拐点开始平均左心室舒张压。亚组分析在左心室射血分数（EF）降低或正常的组中进行。结果与正常EF组（r = 0.33，r2 = 0.11，P = .08）相比，EF降低组（r = 0.73，r2 = 0.53，P <.001）的两种估算mLAP的技术之间有更强的一致性）。在整个研究队列中，一致性的κ统计值为0.34，这表明根据平均mLAP的分配值得出的一致性：<8、8至15和> 15 mm Hg。在该队列中，左心房容积指数与有创估计的mLAP无关。结论在患有急性冠脉综合征的患者中，多普勒和导管得出的mLAP估计值与EF降低的患者有很好的相关性。