优化射血分数保留型心力衰竭的无创诊断:结合左心房顺应性评估的增强型运动负荷超声心动图

Graphical abstract showing a tiered diagnostic workflow for suspected HFpEF in patients with unexplained dyspnoea and ejection fraction ≥50%. Step 1 integrates HFA-PEFF, H2FPEF, and HFpEF-ABA scores. Intermediate-probability patients proceed to Step 2, which uses resting left atrial compliance and exercise medial E/e' to classify patients as rule-in HFpEF, rule-out HFpEF, or indeterminate requiring invasive exercise haemodynamics. The optimized approach reduced invasive testing from approximately 60 to 30 per 100 patients.

亮点

  • 目前用于 HFpEF 的无创诊断算法在联合运动负荷超声心动图时,敏感性有限,整体准确性中等。
  • 将静息左心房顺应性纳入评估(定义为左心房储备应变除以 E/e’)可显著提高敏感性,但也会增加假阳性。
  • 采用针对运动 E/e’ 和左心房顺应性的优化双阈值后,可实现有效的“确诊/排除”分类,将需要有创检查的患者比例从 60% 降至约 30%。
  • 该结果已在一个国际多中心前瞻性队列中得到验证,进一步增强了其可推广性和临床适用性。

Comments

No comments yet. Why don’t you start the discussion?

发表回复