| 摘要: |
| ［摘要］ 目的 分析运动负荷超声心动图指标联合血清可溶性致瘤抑制素2（sST2）/左心房容积指数（LAVI）比值诊断舒张性心力衰竭（DHF）的效能。方法 招募2020年10月至2022年10月胜利油田中心医院收治的120例慢性心力衰竭患者，根据DHF发生情况将其分为DHF组（53例）和非DHF组（67例）。所有患者接受运动负荷超声心动图检查，获取LAVI、二尖瓣口舒张期流速（E）/二尖瓣环舒张早期平均运动速度（e′）比值，计算负荷和静息状态下E/e′变化幅度（△E/e′）。检测血清sST2水平，计算sST2/LAVI比值。采用Pearson相关分析超声心动图指标、血清sST2水平与左室舒张末压（LVEDP）和肺毛细血管楔形压（PCWP）的相关性。采用受试者工作特征（ROC）曲线分析研究指标诊断DHF的效能。结果 DHF组负荷状态下的E/e′比值显著高于静息状态（P<0.05），非DHF组静息和负荷状态下的E/e′比值比较差异无统计学意义（P>0.05）。DHF组静息状态E/e′比值、负荷状态E/e′比值、△E/e′比值、LAVI水平高于非DHF组，sST2水平、sST2/LAVI比值低于非DHF组，差异有统计学意义（P<0.05）。Pearson相关分析结果显示，静息E/e′比值、负荷E/e′比值、△E/e′比值和LAVI与PCWP、LVEDP均呈正相关（P<0.05），sST2和sST2/LAVI比值与PCWP、LVEDP均呈负相关（P<0.05）。ROC曲线分析结果显示，△E/e′比值具有诊断DHF的应用价值［AUC（95%CI）=0.837(0.758～0.898)，P<0.05］，最佳截断值为1.50，其对应的灵敏度和特异度分别为83.02%、83.58%；sST2/LAVI比值也具有诊断DHF的应用价值［AUC（95%CI）=0.804(0.722～0.871)，P<0.05］，最佳截断值为0.75，其对应的灵敏度和特异度分别为81.13%、80.60%。联合△E/e′比值和sST2/LAVI比值两个指标诊断DHF可进一步提高诊断效能［AUC(95%CI)=0.950(0.895～0.982)，P<0.05］，其灵敏度和特异度分别为94.34%、95.52%。结论 与非DHF患者相比，DHF患者△E/e′比值增高，sST2/LAVI比值降低，且与LVEDP、PCWP均呈强相关，联合△E/e′比值、sST2/LAVI比值可为临床诊断DHF提供辅助参考。 |
| 关键词: 舒张性心力衰竭 运动负荷超声心动图 可溶性致瘤抑制素2 左心房容积指数 |
| DOI：10.3969/j.issn.1674-3806.2023.06.16 |
| 分类号:R 541 |
| 基金项目: |
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| Efficacy analysis of exercise stress echocardiographic indicators combined with serum soluble suppression of tumorigenesis 2/left atrial volume index ratio in diagnosis of diastolic heart failure |
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WANG Wei, YAN Ping, LU Rong, et al.
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Department of Ultrasound, Shengli Oilfield Central Hospital, Dongying 257000, China
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| Abstract: |
| ［Abstract］ Objective To analyze the efficacy of exercise stress echocardiographic indicators combined with serum soluble suppression of tumorigenesis 2(sST2)/left atrial volume index(LAVI) ratio in diagnosis of diastolic heart failure(DHF). Methods One hundred and twenty patients with chronic heart failure who were admitted to Shengli Oilfield Central Hospital from October 2020 to October 2022 were recruited and divided into DHF group(53 cases) and non-DHF group(67 cases) according to the occurrence of DHF. All the patients underwent exercise load echocardiography to obtain the ratio of LAVI, mitral annulus diastolic velocity(E) to mitral annulus mean early diastolic velocity(e′) ratio, and the variations of E/e ′ under load and at rest(△E/e′) were calculated. The serum levels of sST2 were detected and sST2/LAVI ratio was calculated. Pearson correlation was used to analyze the correlation of echocardiographic indicators and serum levels of sST2 with left ventricular end diastolic pressure(LVEDP) and pulmonary capillary wedge pressure(PCWP). Receiver operating characteristic(ROC) curve analysis was used to study the diagnostic efficacy of DHF. Results The E/e′ ratio under load in the DHF group was significantly higher than that at rest(P<0.05), but there was no significant difference in the E/e ′ ratio between resting and load states in the non-DHF group(P>0.05). The resting state E/e′ ratio, load state E/e′ ratio, △E/e′ ratio and LAVI level in the DHF group were higher than those in the non-DHF group, while sST2 level and sST2/ LAVI ratio in the DHF group were lower than those in the non-DHF group, and the differences were statistically significant(P<0.05). The results of Pearson correlation analysis showed that resting E/e′ ratio, load E/e′ ratio, △E/e′ ratio and LAVI were positively correlated with PCWP and LVEDP(P<0.05), while sST2 and sST2/ LAVI ratio were negatively correlated with PCWP and LVEDP(P<0.05). The results of ROC curve analysis showed that the △E/e′ ratio had application value in diagnosing DHF［AUC(95%CI)=0.837(0.758-0.898), P<0.05］, and the optimal cut-off value was 1.50, and the corresponding sensitivity and specificity were 83.02% and 83.58%, respectively. The ratio of sST2/ LAVI also had application value in the diagnosis of DHF［AUC(95%CI)=0.804(0.722-0.871), P<0.05］, and the optimal cut-off value was 0.75, and the corresponding sensitivity and specificity were 81.13% and 80.60%, respectively. Combining E/e′ ratio and sST2/ LAVI ratio could further improve the diagnostic efficacy［AUC(95%CI)=0.950(0.895-0.982), P<0.05］, and the sensitivity and specificity were 94.34% and 95.52%, respectively. Conclusion Compared with the non-DHF patients, the DHF patients have elevated ratio of △E/e′ and decreased ratio of sST2/LAVI, which is strongly correlated with both LVEDP and PCWP. The combination of △E/e′ ratio and sST2/LAVI ratio can provide auxiliary reference for clinical diagnosis of DHF. |
| Key words: Diastolic heart failure(DHF) Exercise stress echocardiography Soluble suppression of tumorigenesis 2(sST2) Left atrial volume index(LAVI) |
