目的 应用受试者工作特征(ROC)曲线分析左心室舒张末期压力(LVEDP)及舒张早期经二尖瓣口血流速度与舒张早期二尖瓣环的运动速度比值(E/Ea)、B型脑钠肽(BNP)的关系.方法 收集疑有冠心病行选择性冠状动脉造影检查104例患者进行LVEDP测定,并行多普勒超声心动图检查和BNP测定.分析上述指标的相关性及ROC曲线特征.根据美国纽约心脏病协会(NYHA)的标准对心脏的患者进行心功能分级.结果 104例患者中,86例有器质性心脏病(心功能Ⅰ级及Ⅱ级各18例,心功能Ⅲ级21例,心功能Ⅳ级29例),另18例无明显的心脏病证据.随着心功能分级的增加,LVEDP、BNP及E/Ea比值呈不同程度进行性的恶化.LVEDP与BNP和E/Ea呈正相关(r=0.786,0.651,均P＜0.01),与E/A和Ea/Aa呈负相关(r=-0.231,-0.652,P＜0.05或＜0.01).E/Ea及BNP的ROC曲线下面积分别为0.830及0.951(均P＜0.01).结论 E/Ea比值及BNP能较好地无创性评估LVEDP,但BNP的准确度更高.%Objective To explore the relation between left ventricular end-diastolic pressure(LVEDP) with the ratio of transmitral early diastolic veloeity/mitral annular early diastolic velocity(E/Ea ratio) and B-type natriuretic peptide(BNP) by receiver-operating charaeteristic(ROC) analysis. Methods One-hundred and four patients who were suspected coronary artery disease experienced selected artery angiography,and LVEDP was measured meanwhile. They underwent a thorough Doppler-eehoeardiographie and pulsed tissue-Doppler study and BNP measurement to noninvasively estimate LVEDP. The correlation and ROC curves were analyzed. The functional assessment of the heart failure in patients adopted the New York Heart Association (NYHA) classification. Results A total of 85 patients had organic heart diseases (18 patients with class I of NYHA,18 with class Ⅱ ,21 with class Ⅲ and 29 with class Ⅳ) and the remaining 18 patients had no obvious evidence of heart disease. With the progression of the functional classification, LVEDP,BNP and E/Ea ratio showed different exacerbation. LVEDP had positive correlation with BNP and E/Ea ratio ( r =0. 786,0. 651, both P ＜0.01), but negative correlation with E/A and Fa/Aa( r =-0. 231,-0. 652, P ＜0.05 or ＜ 0.01). The areas under the ROC curves for E/Ea ratio and BNP were 0.830, 0. 951, respectively( P ＜ 0.01). Conclusion LVEDP level can be determined by noninvasive methods of E/Ea ratio and BNP level. The accuracy was better by level of BNP than by E/Ea ratio.
展开▼
