射血分数保留心力衰竭不同诊断标准价值的比较  

Diagnostic value of different strategies in heart failure with preserved ejection fraction

作　　者：谢春林[1] 丛涛[1] 王珂[1] 孙颖慧[1] 商志娟[1] 苏德淳[1] 

机构地区：[1]大连医科大学附属第一医院心内科,辽宁大连116011

出　　处：《中国实用内科杂志》2017年第7期634-637,共4页Chinese Journal of Practical Internal Medicine

基　　金：辽宁省科技计划资助项目(201222520);大连市科技计划资助项目(2014E14SF173)

摘　　要：目的探讨包括替代标准在内的四项射血分数保留的心力衰竭(简称心衰)诊断标准对急性呼吸困难入院患者的诊断价值。方法选取2012年6月至2013年8月因呼吸困难于大连医科大学附属第一医院心内科因呼吸困难住院患者111例,分射血分数保留的心衰组(71例)和对照组(40例),测超声心动图、B型钠尿肽等指标。比较各参数以及2012欧洲心脏学会(ESC)心衰指南、2009欧洲超声心动杂志(EAE/ASE)左室舒张功能建议、2010替代标准和改良标准的价值。结果二尖瓣舒张早期流速与侧壁瓣环组织多普勒速度比值(AUC=0.77)、B型钠尿肽(AUC=0.78)、左房容积指数(AUC=0.73)、左室质量指数(AUC=0.67)和肺静脉心房收缩血流与二尖瓣心房收缩持续时间差(AUC=0.69)的诊断效果最好。与金标准比,替代标准一致性最差(Kappa=0.13,P=0.063),诊断准确率50.5%;2012ESC指南最好(Kappa=0.62,P<0.001),准确率82%;将左房容积指数和B型钠尿肽引入替代标准建立改良标准,Kappa=0.47(P<0.001),准确率73.9%。结论替代标准不适于基层医疗机构诊断射血分数保留心衰,改良标准可能更好。Objective To explore whether the simplified strategy from the 2010 Chinese consensus statements and other three diagnostic criteria are useful for diagnosing heart failure with preserved ejection fraction in patients admitted for acute dyspnoea. Methods Echocardiographic data and B-type natriuretic peptide levels were assessed in 111 consecutive patients admitted for acute dyspnoea. The patients were divided into the heart failure with preserved ejection fraction group （n=71） and the control group （n=40）. Various parameters and the value of four diagnostic criteria, including the 2012 ESC heart failure guideline, the 2009 EAE/ ASE recommendations, simplified and modified diagnostic criteria, were compared. Results The ratio of the early mitral inflow velocity to the tissue Doppler velocity at the lateral mitral annulus （AUC=0.77）, B-type natriuretic peptide （AUC=0.78）, the left atrial volume index （AUC=0.73）, the left ventricular mass index （AUC=0.67）, and the difference between duration of reversed pulmonary vein atrial systolic flow and duration of mitral A wave flow （AUC=0.69） had the greatest diagnostic values among all single parameters. The comparison between the four diagnostic criteria and the clinical golden criterion showed that the Chinese simplified criterion was worst in the consistency test （Kappa=0.13, P=0.063）, with a low diagonistic accuracy （50.5%）. The best diagnostic accuracy （82%） was shownin the 2012 ESC guideline, with a good consistency （Kappa=0.62, P〈0.001）. After the introduction of the left atrial volume index and B-type natriuretic pepfide into the simplified criterion, an acceptable diagnostic accuracy （73.9%） and consistency （Kappa=0.47, P〈0.001） were achieved. Conclusion The simplified criterion from the 2010 Chinese consensus statements is not applicable to the screening of patients admitted to the basic level hospitals for acute dyspnoea. The modified diagnostic criterion is recommended for promotion in primary care.

关 键 词：心力衰竭 诊断 鉴别 超声心动描记术 

分 类 号：R542[医药卫生—心血管疾病]