二尖瓣血流频谱和二尖瓣环舒张速度对射血分数保留的心力衰竭的诊断价值  

Diagnostic values of mitral inflow and mitral annulus diastolic velocity for heart failure with preserved ejection fraction

作　　者：刘永铭[1] 马苏美[2] 杨琳[1] 薛丽丽[2] 乔成栋[1] 王琳[1] 刘艳英[1] 杨京港[1] 

机构地区：[1]兰州大学第一医院老年心血管科,730000 [2]兰州大学第一医院超声诊断科,730000

出　　处：《中华心血管病杂志》2016年第2期150-155,共6页Chinese Journal of Cardiology

基　　金：基金项目：国家临床重点专科建设项目;国家留学人员科技活动择优资助项目（2010年）

摘　　要：目的 探讨超声心动图指标二尖瓣口舒张早期最大充盈速度（E）与晚期最大充盈速度（A）比值（E/A）以及E与二尖瓣环舒张早期最大速度（E’）比值（E/E’）对射血分数保留的心力衰竭（HF-PEF）的诊断价值.方法 入选健康成年人216名,分为＜50岁、50 ～ 59岁、60 ～ 69岁以及≥70岁4个亚组,观察增龄对E/A和E/E’的影响.入选2010年5月至2013年12月在兰州大学第一医院老年病科住院的新诊断的HF-PEF患者202例,同期住院不合并心力衰竭但有其危险因素的患者221例作为阴性对照,进行ROC曲线分析,探讨E/A和E/E’对HF-PEF的诊断价值及其切点.结果 健康成年人不同年龄组间E/A和E/E’差异均有统计学意义（P均＜0.01）,≥70岁组平均E/A较＜50岁组低（P＜0.01）,平均E/E’则较高（P＜0.01）,≥60岁的健康成年人中E/A＜1者占68％（71/105）,E/E’＞8者占48％（50/105）.纽约心脏协会（NYHA）心功能Ⅱ、Ⅲ、Ⅳ级的HF-PEF患者间E/A和E/E’的差异均无统计学意义（P均＞0.05）,但随着NYHA心功能分级加重,NT-proBNP水平升高（P＜0.01）.E/E’在ROC曲线下面积为0.839（P＜0.01）,对应切点为9.5,敏感度为86％,特异度为69％;E/A取值较大作为阳性和取值较小作为阳性在ROC曲线下的面积分别为0.469和0.531（P均＞0.05）.结论 增龄对E/A及E/E’均具有明显影响,E/A对HF-PEF诊断价值有限,E/E’诊断准确性中等.Objective To explore the diagnostic values of ratios of early diastolic peak transmitral velocity（E） to late velocity（A） （E/A） and E to early diastolic peak mitral annulus velocity （E/E＇） for heart failure patients with preserved ejection fraction （HF-PEF）.Methods Two hundred and sixteen healthy people were divided into 〈 50 years,50-59 years,60-69 years,and ≥ 70 years groups to clarify the impact of aging on E/A and E/E＇.Two hundred and two newly diagnosed consecutive in-patients with HF-PEF and 221 age-and sex-matched non-heart-failure subjects with risk factors of HF-PEF （negative controls） were enrolled.The diagnostic values and cutoff points of E/A and E/E＇ for HF-PEF were derived from receiver operating characteristic curve （ROC） analysis.Results E/A and E/E＇ were significantly different among age groups in healthy controls （all P 〈 0.01）.Compared with 〈 50 years group,average E/A was lower and average E/E＇ was higher in ≥70 years group（both P 〈0.01）.E/A ratio was less than 1 in 68% （71/105）,E/E＇ was 〉 8 cm/s in 48% （50/105） healthy people with age ≥ 60 years.Neither E/A nor E/E＇ of HF-PEF patients was statistically different regarding to NYHA classification （grade Ⅱ,Ⅲ,Ⅳ）,but NT-proBNP value increased in proportion to higher NYHA classification（P 〈 0.01）.The area of E/E＇ under ROC for diagnosing HF-PEF was 0.839 （P 〈 0.01）,and the corresponding cutoff point was 9.5 with a sensitivity of 86% and a specificity of 69%.The areas of E/A （larger value or smaller value indicating positive） under ROC for diagnosing HF-PEF were 0.469 and 0.531,respectively （all P 〉 0.05）.Conclusions Aging exerts significant impacts on both E/A and E/E＇.E/E＇ has moderate diagnostic accuracy while E/A is of limited value for diagnosing HF-PEF.

关 键 词：心力衰竭 充血性 超声心动描记术 

分 类 号：R541.6[医药卫生—心血管疾病]