双脉冲多普勒超声心动图评估冠状动脉粥样硬化性心脏病患者左心室充盈压力升高的应用价值

Application of Double-pulse Doppler Echocardiography in Evaluating Elevated Left Ventricular Filling Pressure in Patients with Coronary Heart Disease

目的探讨双脉冲多普勒超声心动图测量左心室舒张功能相关参数与冠状动脉粥样硬化性心脏病(简称冠心病)患者左心室充盈压力升高的关系。方法选择2020年3—10月收治的左心室射血分数(LVEF)>50%的冠心病患者53例(冠心病组),选择同期健康志愿者38例作为健康对照组。冠心病组患者均行冠脉造影、心导管检查测量左心室舒张末期压力(LVEDP),并将冠心病组患者分为LVEDP≤15 mmHg(1 mmHg=0.133 kPa)组(n=23)和LVEDP>15 mmHg组(n=30)。应用双脉冲多普勒超声心动图测量左心室舒张功能相关参数。采用单因素和多因素logistic回归分析法筛选预测LVEDP升高的超声心动图指标;绘制超声心动图相关参数诊断LVEDP升高的受试者操作特征(ROC)曲线。结果多因素logistic回归分析结果表明,双脉冲多普勒超声心动图测量的单个心动周期的T_(E-e’)和E/e’_(S)可以预测LVEDP的升高。ROC曲线表明,E/e’_(S)≥10.6诊断LVEDP升高的敏感度为87%,特异度为52%,曲线下面积(AUC)为0.714;T_(E-e’)≥36 ms诊断LVEDP升高的敏感度为57%,特异度为91%,AUC为0.804;联合T_(E-e’)≥36 ms和E/e’_(S)≥10.6诊断LVEDP升高的敏感度为83%,特异度为78%,AUC为0.862。结论双脉冲多普勒超声心动图测量T_(E-e’)联合E/e’_(S)可以用于评估冠心病患者左心室充盈压力的升高。

Objective To explore the relationship between the parameters of left ventricular diastolic function measured by double pulse doppler echocardiography and the increase of left ventricular filling pressure in patients with coronary heart disease(CAD).Methods A total of 53 CAD patients with left ventricular ejection fraction(LVEF)>50%were in CAD group,and 38 age and sex matched healthy volunteers were in the control group.All patients in the CAD group underwent coronary angiography and cardiac catheterization to measure left ventricular end diastolic pressure(LVEDP),and CAD group was divided into group 1(LVEDP≤15mmHg,1 mmHg=0.133 kPa)and group 2(LVEDP>15 mmHg).The parameters related to left ventricular diastolic function were measured systematically by double pulse Doppler echocardiography.The echocardiographic indexes of elevated left ventricular filling pressure were predicted by univariate and multivariate logistic regression analysis.The area under the curve(AUC)was calculated by receiver operating characteristic(ROC)curve,to determine the accuracy of echocardiography related parameters in the diagnosis of LVEDP elevation.Results Multivariate logistic regression analysis showed that T_(E-e’)and E/e’_(S)of a single cardiac cycle measuredby double-pulse Doppler echocardiography could significantly predict the increase in LVEDP.ROC curve analysis showed that the optimal cut-off for T_(E-e’)was 36 ms(sensitivity 57%,specificity 91%,AUC 0.804)and that for E/e’was 10.6(sensitivity 87%,specificity 52%,AUC 0.714).The combined cut-offs of T_(E-e’)≥36 ms and E/e’_(S)≥10.6,had a sensitivity of83%and a specificity of 78%in diagnosing LVEDP elevation with an AUC of 0.862.Conclusions The measurement of T_(E-e’)combined with E/e’_(S)by double-pulse Doppler echocardiography can be used as a good indicator to evaluate the increase of left ventricular filling pressure in CAD patients.