E/Em比值对心房颤动患者舒张性心力衰竭的诊断价值

目的 评价二尖瓣舒张早期血流峰速度E与二尖瓣环舒张早期运动峰速度Em之比(E/Em)诊断心房颤动患者舒张性心力衰竭(DHF)的价值.方法 将左心室射血分数(LVEF)正常的98例非瓣膜病心房颤动患者分为DHF组(62例)和非心力衰竭(NHF)两组(36例).对两组临床资料和超声心动图参数进行比较,应用ROC曲线评价E/Em诊断心房颤动患者DHF的价值.结果 与NHF组比较,DHF组年龄更大,合并高血压比例更多,NT-proBNP更高,左心房增大,E峰增高,Em降低,E/Em增高(P＜0.001).E/Em诊断DHF的ROC曲线下面积为0.770(95％CI:0.675～0.865).以E/Em≥9.50为截点时,诊断DHF的敏感度、特异度、阳性预测值及阴性预测值分别为67.7％、72.2％、71.0％和69.1％.结论 E/Em比值对诊断心房颤动患者DHF具有较好的应用价值.

E/Em ratio for assessment of diastolic heart failure in patients with atrial fibrillation

Objective To observe the diagnostic value of the ratio of early diastolic transmitral velocity to early diastolic mitral annular velocity(E/Em) for diastolic heart failure(DHF) in patients with atrial fibrillation.Methods Patients with nonvalvular atrial fibrillation and normal left ventricular ejection fraction(LVEF) were enrolled in the study,which were classified into DHF group(n=62) and non-heart failure group(NHF group,n=36).The clinical and echocardiographic data were compared between the two groups.ROC curve was used to assess the value of E/Em for the identification of DHF.Results Compared with NHF group,patients with DHF were older,more had hypertension,higher NT-proBNP,larger left atrial,higher E,lower Em and higher E/Em(P<0.001).Using E/Em for identification of DHF,the area under ROC curve was 0.770(95%CI: 0.675—0.865).Taking E/Em ≥9.50 as optimal cut-off value,the sensitivity,specificity,positive predictive value and negative predictive value was 67.7%,72.2%,71.0% and 69.1%,respectively.Conclusion E/Em could be useful in identifying DHF in patients with atrial fibrillation.