超声心动图用于老年高血压射血分数保留型心力衰竭诊断及预后评估临床价值探究

Clinical value of echocardiography in the diagnosis and prognosis evaluation of the elderly with hypertension and heart failure with preserved ejection fraction

目的 探讨超声心动图对老年高血压射血分数保留型心力衰竭(HFpEF)的诊断及预后评估价值。方法 回顾性选取2021年1月至2023年1月临汾市中心医院收治的105例高血压合并HFpEF患者为HFpEF组,选取同期50例单纯高血压患者为高血压组,另选取同期50名健康志愿者为健康组。所有纳入对象均行超声心动图检查,HFpEF组患者随访6个月,根据随访过程中是否出现心脏不良事件(MACE)分为MACE组和无MACE组。比较各组超声心动图指标[舒张末期室间隔厚度(IVST)、左室射血分数(LVEF)、左室舒张末期内径(LVEDD)、二尖瓣舒张早期、晚期血流速度比值(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)]变化;通过受试者特征(ROC)曲线分析超声心动图指标对高血压合并HFpEF的诊断、预后价值。结果 HFpEF组、高血压组患者的IVST、LVEDD、E/e’、LAVI均高于健康组,HFpEF组E/A低于健康组,HFpEF组IVST、LVEDD、E/e’、LAVI均高于高血压组,差异均有统计学意义(P<0.05)。高血压合并HFpEF患者随访6个月结果显示,35例发生MACE。MACE组的IVST、LVEDD、E/e’和LAVI均高于无MACE组,差异均有统计学意义(P<0.05);MACE组与无MACE组LVEF、E/A比较,差异均无统计学意义(P>0.05)。IVST、LVEDD、E/e’、LAVI及其联合时对高血压合并HFpEF诊断的ROC曲线下面积(AUC)分别为0.728、0.702、0.877、0.885、0.976,联合时AUC高于其单独检测(P<0.05)。IVST、LVEDD、E/e’、LAVI及其联合时对高血压合并HFpEF患者MACE的AUC分别为0.788、0.767、0.893、0.781、0.989,联合时AUC高于其单独检测(P<0.05)。结论 超声心动图中的IVST、LVEDD、E/e’、LAVI对高血压合并HFpEF具有良好的诊断价值和MACE发生的预测价值,4项指标联合的诊断效能和预后预测效能更高。

Objective To explore the value of echocardiography in the diagnosis and prognosis evaluation of the elderly with hypertension and heart failure with preserved ejection fraction(HFpEF).Methods A total of 105 patients with hypertension complicated with HFpEF admitted to Linfen Central Hospital from January 2021 to January 2023 were retrospectively selected as the HFpEF group,50 patients with simple hypertension during the same period were selected as the hypertension group,and 50 healthy volunteers during the same period were selected as the healthy group.All underwent echocardiography.The patients in HFpEF group were followed up for 6 months.According to presence or absence of major adverse cardiac events(MACE) during follow-up,they were divided into the MACE group and the non-MACE group.The changes of echocardiography indicators [end diastolic interventricular septal thickness(IVST),left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(LVEDD),ratio of early blood flow peak velocity to end-diastolic peak blood flow velocity(E/A),ratio of early diastolic transmitral velocity to early diastolic mitral annular velocity(E/e '),and left atrial volume index(LAVI)] were compared among different groups.The diagnostic and prognostic value of echocardiography indexes for hypertension combined with HFpEF was analyzed by receiver operating characteristic(ROC) curves.Results The IVST,LVEDD,E/e ',and LAVI of patients in the HFpEF group and hypertension group were higher than those in the healthy group,while the E/A of the HFpEF group was lower than that of the healthy group.The IVST,LVEDD,E/e',and LAVI of patients in the HFpEF group were higher than those in the hypertension group,and the differences were statistically significant(P<0.05).The results of 6-month follow-up showed that there were 35 patients with MACE.The IVST,LVEDD,E/e ',and LAVI of the MACE group were higher than those of the non MACE group,and the differences were statistically significant(P<0.05);there were no statistically significant differences in LVEF and E/A between the MACE group and the non MACE group(P>0.05).The area under ROC area under the curve(AUC) values of IVST,LVEDD,E/e ',LAVI and combined detection in the diagnosis of hypertension combined with HFpEF were 0.728,0.702,0.877,0.885 and 0.976,respectively.AUC of combined detection was greater than that of single index(P<0.05).AUC values of IVST,LVEDD,E/e ',LAVI and combined detection for predicting MACE were 0.788,0.767,0.893,0.781 and 0.989,respectively.AUC of combined detection was greater than that of single index(P<0.05).Conclusion IVST,LVEDD,E/e 'and LAVI have good diagnostic value for hypertension combined with HFpEF and predictive value for MACE.The diagnostic efficiency and predictive value of combined detection are higher.