Garganeeva Alla A., V. V. Kirillova, E. Kuzheleva, R. Batalov, A. Smorgon, S. Mayanskaya
{"title":"阵发性和长期持续性房颤患者液体潴留的评估","authors":"Garganeeva Alla A., V. V. Kirillova, E. Kuzheleva, R. Batalov, A. Smorgon, S. Mayanskaya","doi":"10.15275/rusomj.2023.0105","DOIUrl":null,"url":null,"abstract":"Determining fluid retention in circulatory system currently remains a challenge. The objective of our study was to determine the sensitivity of individual symptoms and signs of chronic heart failure (CHF) and echocardiographic criteria for detecting fluid retention in patients with atrial fibrillation and invasively measured elevated atrial pressure. Methods — We conducted a prospective study of adult patients with a history of cardiovascular disease (coronary artery disease or/and arterial hypertension in combination with atrial fibrillation [AF]) hospitalized for radiofrequency catheter ablation. All patients underwent expert ultrasound examination of the heart using Philips HD 15 and Philips iE33 devices, as well as invasive measurement of pressure in the left and right atria at rest (n=20). Results — The sensitivity of dyspnea in patients with paroxysmal AF and long-standing persistent AF was 44.4% and 90.9%, respectively. The sensitivity of the mean E/e' ratio in patients with paroxysmal AF and long-standing persistent AF was 22.2% and 18.1%, correspondingly. According to the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging (ASE/EACVI) algorithm, only one patient (11.1%) in the group with paroxysmal AF and 54.5% of subjects in the group with a long-standing persistent AF type had two positive criteria. The sensitivity of lower limb edema was 0% in patients with paroxysmal AF and 57.1% in those with long-standing persistent AF. The sensitivity of IVC diameter >22 mm was 80% in patients with paroxysmal AF and 57.1% in the group with long-standing persistent AF. At the same time, the sensitivity of the IVC inspiratory collapse ≤50% was significantly lower in both groups: 60% in patients with paroxysmal AF and 42.9% in subjects with long-standing persistent AF. Conclusion — Clinical symptoms and signs of chronic heart failure (CHF), as well as echocardiographic parameters reflecting an increase in the filling pressure of the heart chambers, are characterized by extremely low sensitivity in a cohort of patients with paroxysmal AF. The use of more stringent criteria for diagnosing congestion in this group of patients leads to a significant underdiagnosis of elevated filling pressure in the left chambers of the heart, which, in turn, increases the likelihood of insufficient prescription of diuretic therapy when it is objectively necessary.","PeriodicalId":21426,"journal":{"name":"Russian Open Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.2000,"publicationDate":"2023-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Assessment Of Fluid Retention In Patients With Paroxysmal And Long-Standing Persistent Types Of Atrial Fibrillation\",\"authors\":\"Garganeeva Alla A., V. V. Kirillova, E. Kuzheleva, R. Batalov, A. Smorgon, S. Mayanskaya\",\"doi\":\"10.15275/rusomj.2023.0105\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Determining fluid retention in circulatory system currently remains a challenge. The objective of our study was to determine the sensitivity of individual symptoms and signs of chronic heart failure (CHF) and echocardiographic criteria for detecting fluid retention in patients with atrial fibrillation and invasively measured elevated atrial pressure. Methods — We conducted a prospective study of adult patients with a history of cardiovascular disease (coronary artery disease or/and arterial hypertension in combination with atrial fibrillation [AF]) hospitalized for radiofrequency catheter ablation. All patients underwent expert ultrasound examination of the heart using Philips HD 15 and Philips iE33 devices, as well as invasive measurement of pressure in the left and right atria at rest (n=20). Results — The sensitivity of dyspnea in patients with paroxysmal AF and long-standing persistent AF was 44.4% and 90.9%, respectively. The sensitivity of the mean E/e' ratio in patients with paroxysmal AF and long-standing persistent AF was 22.2% and 18.1%, correspondingly. According to the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging (ASE/EACVI) algorithm, only one patient (11.1%) in the group with paroxysmal AF and 54.5% of subjects in the group with a long-standing persistent AF type had two positive criteria. The sensitivity of lower limb edema was 0% in patients with paroxysmal AF and 57.1% in those with long-standing persistent AF. The sensitivity of IVC diameter >22 mm was 80% in patients with paroxysmal AF and 57.1% in the group with long-standing persistent AF. At the same time, the sensitivity of the IVC inspiratory collapse ≤50% was significantly lower in both groups: 60% in patients with paroxysmal AF and 42.9% in subjects with long-standing persistent AF. Conclusion — Clinical symptoms and signs of chronic heart failure (CHF), as well as echocardiographic parameters reflecting an increase in the filling pressure of the heart chambers, are characterized by extremely low sensitivity in a cohort of patients with paroxysmal AF. The use of more stringent criteria for diagnosing congestion in this group of patients leads to a significant underdiagnosis of elevated filling pressure in the left chambers of the heart, which, in turn, increases the likelihood of insufficient prescription of diuretic therapy when it is objectively necessary.\",\"PeriodicalId\":21426,\"journal\":{\"name\":\"Russian Open Medical Journal\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":0.2000,\"publicationDate\":\"2023-03-28\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Russian Open Medical Journal\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.15275/rusomj.2023.0105\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Russian Open Medical Journal","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.15275/rusomj.2023.0105","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 0
摘要
目前,确定循环系统中的液体潴留仍然是一个挑战。本研究的目的是确定慢性心力衰竭(CHF)的个体症状和体征的敏感性,以及超声心动图检测心房颤动患者液体潴留和有创测量心房压升高的标准。方法:我们对有心血管疾病(冠状动脉疾病或/和动脉高血压合并心房颤动[AF])病史的住院射频导管消融的成年患者进行了一项前瞻性研究。所有患者均使用Philips HD 15和Philips iE33设备进行专家心脏超声检查,并有创测量静息时左、右心房压力(n=20)。结果:阵发性房颤和长期持续性房颤患者呼吸困难的敏感性分别为44.4%和90.9%。阵发性房颤和长期持续性房颤的平均E/ E比值敏感性分别为22.2%和18.1%。根据2016年美国超声心动图学会/欧洲心血管成像协会(ASE/EACVI)算法,阵发性房颤组中只有1例(11.1%)患者和长期持续性房颤组中54.5%的受试者有两个阳性标准。阵发性房颤患者下肢水肿的敏感性为0%,长期持续性房颤患者下肢水肿的敏感性为57.1%。阵发性房颤患者下肢水肿的敏感性为80%,长期持续性房颤患者下肢水肿的敏感性为57.1%。同时,两组下肢水肿吸入塌陷≤50%的敏感性均显著低于阵发性房颤患者;60%为阵发性房颤患者,42.9%为长期持续性房颤患者慢性心力衰竭(CHF)的临床症状和体征,以及反映心室充盈压力增加的超声心动图参数,在阵发性房颤患者队列中具有极低敏感性的特点。在这组患者中使用更严格的诊断充血标准导致严重漏诊心脏左室充盈压力升高,反过来,客观上必要时,增加利尿治疗处方不足的可能性。
Assessment Of Fluid Retention In Patients With Paroxysmal And Long-Standing Persistent Types Of Atrial Fibrillation
Determining fluid retention in circulatory system currently remains a challenge. The objective of our study was to determine the sensitivity of individual symptoms and signs of chronic heart failure (CHF) and echocardiographic criteria for detecting fluid retention in patients with atrial fibrillation and invasively measured elevated atrial pressure. Methods — We conducted a prospective study of adult patients with a history of cardiovascular disease (coronary artery disease or/and arterial hypertension in combination with atrial fibrillation [AF]) hospitalized for radiofrequency catheter ablation. All patients underwent expert ultrasound examination of the heart using Philips HD 15 and Philips iE33 devices, as well as invasive measurement of pressure in the left and right atria at rest (n=20). Results — The sensitivity of dyspnea in patients with paroxysmal AF and long-standing persistent AF was 44.4% and 90.9%, respectively. The sensitivity of the mean E/e' ratio in patients with paroxysmal AF and long-standing persistent AF was 22.2% and 18.1%, correspondingly. According to the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging (ASE/EACVI) algorithm, only one patient (11.1%) in the group with paroxysmal AF and 54.5% of subjects in the group with a long-standing persistent AF type had two positive criteria. The sensitivity of lower limb edema was 0% in patients with paroxysmal AF and 57.1% in those with long-standing persistent AF. The sensitivity of IVC diameter >22 mm was 80% in patients with paroxysmal AF and 57.1% in the group with long-standing persistent AF. At the same time, the sensitivity of the IVC inspiratory collapse ≤50% was significantly lower in both groups: 60% in patients with paroxysmal AF and 42.9% in subjects with long-standing persistent AF. Conclusion — Clinical symptoms and signs of chronic heart failure (CHF), as well as echocardiographic parameters reflecting an increase in the filling pressure of the heart chambers, are characterized by extremely low sensitivity in a cohort of patients with paroxysmal AF. The use of more stringent criteria for diagnosing congestion in this group of patients leads to a significant underdiagnosis of elevated filling pressure in the left chambers of the heart, which, in turn, increases the likelihood of insufficient prescription of diuretic therapy when it is objectively necessary.
期刊介绍:
Russian Open Medical Journal (RusOMJ) (ISSN 2304-3415) is an international peer reviewed open access e-journal. The website is updated quarterly with the RusOMJ’s latest original research, clinical studies, case reports, reviews, news, and comment articles. This Journal devoted to all field of medicine. All the RusOMJ’s articles are published in full on www.romj.org with open access and no limits on word counts. Our mission is to lead the debate on health and to engage, inform, and stimulate doctors, researchers, and other health professionals in ways that will improve outcomes for patients. The RusOMJ team is based mainly in Saratov (Russia), although we also have editors elsewhere in Russian and in other countries.