老年射血分数保留心力衰竭病人超声心动图相关参数的研究分析

Analysis of echocardiography parameters in elderly patients with heart failure with preserved ejection fraction

目的探讨超声心动图参数在老年射血分数保留心力衰竭(HFpEF)病人中的诊断价值。方法选取2019年11月至2021年1月期间在南京医科大学第一附属医院老年心血管科住院的76例HFpEF病人作为观察组,54例无心力衰竭病人作为对照组。收集所有病人的一般资料、N末端B型脑钠肽前体(NT-proBNP)水平和常规生化指标结果,并进行超声心动图检测。结果HFpEF组合并房颤、利尿剂使用的比例及NT-proBNP水平均显著高于对照组,差异有统计学意义(P<0.01)。HFpEF组病人左房内径(LAD)、左室内径(LVD)、LVEF、舒张早期二尖瓣血流速度与舒张晚期二尖瓣血流速度比值(E/A)、二尖瓣口E峰流速与二尖瓣环舒张早期峰值速度比值(E/e′)、左房容积指数(LAVI)、三尖瓣反流速度(TRV)均高于对照组,差异有统计学意义(P<0.01)。ROC曲线分析结果显示,LAVI诊断HFpEF的AUC为0.976,大于E/e′、NT-proBNP及TRV;当LAVI取值为31.43 mL/m^(2)时为最佳诊断界值,灵敏度为0.98,特异度为0.89。Spearman相关分析显示,LAVI与LAD、E/A、E/e′、TRV、NT-proBNP呈正相关,而与年龄、SBP无显著相关性。结论LAVI对临床诊治老年HFpEF病人有更大的指导意义。

Objective To investigate the diagnostic value of echocardiography parameters in the elderly patients with heart failure with preserved ejection fraction(HFpEF).Methods A total of 76 HFpEF patients admitted to the Geriatric Cardiology Department of the First Affiliated Hospital with Nanjing Medical University from November 2019 to January 2021 were selected as observation group and 54 patients without heart failure as control group.General data,N-terminal B-type natriuretic peptide(NT-proBNP)level and conventional biochemical index results of all the patients were collected,and the echocardiography parameters detection was performed.Results The incidence of atrial fibrillation,diuretic use and the level of NT-proBNP in HFpEF group were significantly higher than those in control group(P<0.01).The levels of left atrium diameter(LAD),left ventricular diameter(LVD),left ventricular ejection fraction(LVEF),left atrial volume index(LAVI)and tricuspid regurgitation velocity(TRV),and the ratio of peak transmitral flow velocities of early to late in diastole(E/A)and transmitral flow velocities to mitral annulus tissue velocities in early diastole(E/e′)in HFpEF group were higher than those in control group(P<0.01).Receiver operating characteristic curve analysis showed that the area under curve(AUC)of HFpEF diagnosed by LAVI was 0.976,which was higher than E/e′,NT-proBNP and TRV.When the cut-off value of LAVI was 31.43 mL/m^(2),the sensitivity and specificity was 0.98 and 0.89 respectively.Spearman correlation analysis showed that LAVI was positively correlated with LAD,E/A,E/e′,TRV and NT-proBNP,but not significantly correlated with age and systolic blood pressure.Conclusions LAVI has a greater guiding significance for the clinical diagnosis and treatment of elderly patients with HFpEF.