保留左心室射血分数患者的肺超声评估运动性肺充血,并参考运动超声心动图排除心肌缺血

C. Granger, L. Legrand, Y. Allali, P. Guedeney, R. Isnard, F. Pousset, J.P. Collet, G. Montalescot, N. Hammoudi
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引用次数: 0

摘要

肺超声(LUS)可在心力衰竭患者进行压力测试时检测出b线评估的肺充血。运动b线可以帮助早期诊断保留左心室射血分数(LVEF)的心力衰竭。本研究旨在评估运动超声心动图排除心肌缺血的运动性肺动脉充血患者。方法回顾性分析某三级心脏病中心引导性心肌缺血调查中LVEF≥50%患者静息及运动后应激超声合并LUS的资料。通过扫描2个胸部部位来评估b线。运动引起的肺充血定义为基线和运动之间b线增加≥2。结果共纳入1114例患者。平均年龄63岁,54%的患者有高血压,27%的患者有糖尿病。131例(12%)患者存在运动引起的肺充血。年龄、左房容积指数(LAVi)、静息及20 W间隔E/ E′>15和峰值三尖瓣反流速度(TRV)与运动诱导的b线增加有关。在多变量分析中,LAVi (OR = 1.03;95%置信区间(CI): 1.01-1.06;P = 0.003)和峰值TRV (OR = 3.8;95%置信区间:1.4—-10.1;P = 0.009)是运动性肺充血的独立预测因子。结论LVEF保留患者可诊断运动性肺充血,排除诱发性心肌缺血。运动b线与左室舒张功能障碍指数相关。
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Exercise-induced pulmonary congestion assessed by lung ultra sound in patients with preserved left ventricular ejection fraction referred for exercise echocardiography to rule out myocardial ischemia

Introduction

Lung ultrasound (LUS) can detect pulmonary congestion assessed by B-lines in heart failure patients undergoing stress test. Exercise B-lines could help diagnose heart failure with preserved left ventricular ejection fraction (LVEF) at an early stage. This study aimed to assess exercise-induced pulmonary congestion in patients with preserved LVEF referred for exercise echocardiography to rule out myocardial ischemia.

Method

Data of stress echocardiography combined with LUS at rest and immediately after exercise in patients with LVEF ≥ 50% referred for investigation of inducible myocardial ischemia in a tertiary center of cardiology were retrospectively analyzed. B-lines were assessed by scanning 2 chest sites. Exercise-induced pulmonary congestion was defined as an increase of B-lines ≥ 2 between baseline and exercise.

Results

A total of 1114 patients were included. Mean age was 63 years, 54% of patients had hypertension and 27% had diabetes. Exercise-induced pulmonary congestion was identified in 131 (12%) patients. Age, left atrial volume index (LAVi), resting and 20 W septal E/e’ > 15 and peak tricuspid regurgitation velocity (TRV) were associated with increased exercise-induced B-lines. At multivariable analysis, LAVi (OR = 1.03; 95% confidence interval (CI): 1.01–1.06; P = 0.003) and peak TRV (OR = 3.8; 95%CI: 1.4–10.1; P = 0.009) were independent predictors of exercise-induced pulmonary congestion.

Conclusion

Exercise-induced pulmonary congestion could be diagnosed in patients with preserved LVEF referred to rule out inducible myocardial ischemia. Exercise B-lines are linked with left ventricular diastolic dysfunction indices.

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来源期刊
Archives of Cardiovascular Diseases Supplements
Archives of Cardiovascular Diseases Supplements CARDIAC & CARDIOVASCULAR SYSTEMS-
自引率
0.00%
发文量
508
期刊介绍: Archives of Cardiovascular Diseases Supplements is the official journal of the French Society of Cardiology. The journal publishes original peer-reviewed clinical and research articles, epidemiological studies, new methodological clinical approaches, review articles, editorials, and Images in cardiovascular medicine. The topics covered include coronary artery and valve diseases, interventional and pediatric cardiology, cardiovascular surgery, cardiomyopathy and heart failure, arrhythmias and stimulation, cardiovascular imaging, vascular medicine and hypertension, epidemiology and risk factors, and large multicenter studies. Additionally, Archives of Cardiovascular Diseases also publishes abstracts of papers presented at the annual sessions of the Journées Européennes de la Société Française de Cardiologie and the guidelines edited by the French Society of Cardiology.
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