Validation of Left Ventricular Filling Pressure Evaluation by Order of Tricuspid and Mitral Valve Opening in Patients With Atrial Fibrillation.

IF 6.5 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Circulation: Cardiovascular Imaging Pub Date : 2024-11-01 Epub Date: 2024-11-13 DOI:10.1161/CIRCIMAGING.124.017134

Hisao Nishino, Michito Murayama, Hiroyuki Iwano, Nobuyuki Kagiyama, Yutaka Nakamura, Yuka Akama, Misako Toki, Sachiko Takamatsu, Taiji Okada, Yasuyuki Chiba, Masahiro Nakabachi, Shinobu Yokoyama, Mana Goto, Yukino Suzuki, Suguru Ishizaka, Ko Motoi, Yoji Tamaki, Hiroyuki Aoyagi, Kosuke Nakamura, Sanae Kaga, Chiaki Watanabe, Kiwamu Kamiya, Toshiyuki Nagai, Takanori Teshima, Toshihisa Anzai

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Abstract

Background: Accurate assessment of left ventricular filling pressure in patients with atrial fibrillation or flutter (AF) remains difficult. A novel 2-dimensional scoring system, visually assessing time difference between mitral valve and tricuspid valve opening (VMT) score, based on temporal analysis of early diastolic valve opening, could be applied to these patients. We aimed to determine the usefulness of the VMT score in patients with AF.

Methods: We analyzed 119 consecutive patients with AF who underwent cardiac catheterization as a derivation cohort. The diagnostic performance of the VMT score was further evaluated in an external data set containing 189 patients with AF. Elevated left ventricular filling pressure was defined as a mean pulmonary arterial wedge pressure ≥15 mm Hg. The time sequence of atrioventricular valve opening was visually assessed and scored (0, tricuspid valve first; 1, simultaneous; 2, mitral valve first). When the inferior vena cava was dilated, 1 point was added, and the VMT score was finally graded as 0 to 3. Conventional Doppler parameters to estimate left ventricular filling pressure were also measured.

Results: Pulmonary arterial wedge pressure was elevated with an increase in the VMT score (0: 10±3, 1: 13±5, 2: 22±7, 3: 27±6 mm Hg; P<0.001), resulting in a significant rise in pulmonary arterial wedge pressure from VMT score 1 to 2. VMT≥2 predicted elevated pulmonary arterial wedge pressure with an accuracy of 87%, and the diagnostic accuracy of the VMT score was significantly higher than that of conventional Doppler parameters (C index, 0.88 versus 0.54-0.68; P<0.001). In addition, VMT ≥2 showed an incremental predictive value over plasma brain natriuretic peptide levels (C index, 0.79-0.93; P<0.001). In the external validation cohort, VMT≥2 demonstrated acceptable accuracy of 72%.

Conclusions: VMT scoring was a useful echocardiographic marker of elevated left ventricular filling pressure and had an incremental benefit over practical biomarkers in patients with AF.

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通过三尖瓣和二尖瓣开放顺序评估心房颤动患者左心室充盈压的有效性。

背景：准确评估心房颤动或扑动（房颤）患者的左心室充盈压仍然很困难。一种新颖的二维评分系统--视觉评估二尖瓣和三尖瓣开放时间差（VMT）评分--基于对舒张早期瓣膜开放的时间分析，可应用于这些患者。我们的目的是确定 VMT 评分在房颤患者中的实用性：我们分析了 119 名连续接受心导管检查的房颤患者，将其作为衍生队列。在包含 189 名房颤患者的外部数据集中进一步评估了 VMT 评分的诊断性能。左心室充盈压升高被定义为平均肺动脉楔压≥15 毫米汞柱。对房室瓣开放的时间顺序进行目测和评分（0，三尖瓣先开放；1，同时开放；2，二尖瓣先开放）。此外，还测量了用于估算左心室充盈压的常规多普勒参数：结果：肺动脉楔压随着 VMT 评分的增加而升高（0：10±3，1：13±5，2：22±7，3：27±6 mm Hg；PC 指数，0.88 对 0.54-0.68；PC 指数，0.79-0.93；PC 结论：VMT 评分是一项有用的超声检查：VMT 评分是左心室充盈压升高的有用超声心动图标记，与房颤患者的实用生物标记物相比具有增量效益。

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来源期刊

Circulation: Cardiovascular Imaging 医学-核医学

CiteScore

6.30

自引率

2.70%

发文量

225

审稿时长

6-12 weeks

期刊介绍： Circulation: Cardiovascular Imaging, an American Heart Association journal, publishes high-quality, patient-centric articles focusing on observational studies, clinical trials, and advances in applied (translational) research. The journal features innovative, multimodality approaches to the diagnosis and risk stratification of cardiovascular disease. Modalities covered include echocardiography, cardiac computed tomography, cardiac magnetic resonance imaging and spectroscopy, magnetic resonance angiography, cardiac positron emission tomography, noninvasive assessment of vascular and endothelial function, radionuclide imaging, molecular imaging, and others. Article types considered by Circulation: Cardiovascular Imaging include Original Research, Research Letters, Advances in Cardiovascular Imaging, Clinical Implications of Molecular Imaging Research, How to Use Imaging, Translating Novel Imaging Technologies into Clinical Applications, and Cardiovascular Images.