运动时左心房容积的增加与动脉高血压患者舒张压测试的阳性结果有关。

IF 0.5 4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS

Kardiologiya Pub Date : 2024-03-31 DOI:10.18087/cardio.2024.3.n2643

E S Mazur, V V Mazur, N D Bazhenov, O V Nilova, T O Nikolaeva, D V Alekseev

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Patients with positive DST were older (65.0 and 59.0 years); among them, there were fewer men (24.4 and 41.1%), but more patients with obesity (66.7 and 40.3%) and diabetes mellitus (36.7 and 8.5%). At rest, patients with positive DST had higher E/e' ratio (11.5 and 8.8), pulmonary artery systolic pressure (29.0 and 27.0 mm Hg), and LAV (60.0 and 52.0 ml), but a lower left atrial reservoir strain (20.0 and 24.0%). During exercise in patients with positive and negative DST, E/e' increased by 5.46 and 0.47 units, respectively. Changes in the LAV and reservoir strain during exercise in these groups were directed differently. In patients with positive DST, the left atrial reservoir strain decreased by 1.0 percentage points (pp) whereas in patients with negative DST, it increased by 8.0 pp. During exercise, the LAV increased by 10.0 ml in patients with a positive DST, whereas in the alternative group, the LAV decreased by 8.5 ml. 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引用次数: 0

摘要

目的：研究动脉高血压（AH）患者运动时左心房容积（LAV）的变化与舒张压力试验（DST）结果之间的关系：研究对象包括219名无缺血性心脏病和心房颤动的动脉高血压患者。在运动前后进行的 DST 期间，测定了二尖瓣口血流速度与二尖瓣瓣环速度之比（E/e'）、左心房贮血期整体纵向应变（贮血应变）和 LAV。DST 阳性的标准是 E/e' 增加≥15：90例（41.1%）患者的DST结果为阳性。DST 阳性的患者年龄较大（65.0 岁和 59.0 岁）；其中男性较少（24.4% 和 41.1%），但肥胖（66.7% 和 40.3%）和糖尿病（36.7% 和 8.5%）患者较多。静息时，DST 阳性患者的 E/e' 比值（11.5 和 8.8）、肺动脉收缩压（29.0 和 27.0 毫米汞柱）和 LAV（60.0 和 52.0 毫升）较高，但左心房储压应变（20.0 和 24.0%）较低。DST 阳性和阴性患者在运动时，E/e'分别增加了 5.46 和 0.47 个单位。这两组患者运动时 LAV 和储腔应变的变化方向不同。在 DST 阳性的患者中，左心房储压应变降低了 1.0 个百分点（pp），而在 DST 阴性的患者中，左心房储压应变增加了 8.0 个百分点。在运动过程中，DST 阳性患者的左心房储血量增加了 10.0 毫升，而替代组患者的左心房储血量减少了 8.5 毫升。作为 DST 阳性指标的 LAV 变化的 AUC 为 0.987，而静息左心房储库应变的 AUC 为 0.938。以 LAV 增加 1 毫升作为 DST 阳性指标的敏感性为 96.9%，特异性为 95.1%：在AH患者中，左心室充盈压的变化与LAV的单向变化有关。运动时左心室充盈压增加超过 1 毫升可作为 DST 阳性结果的标准。在 94.5% 的病例中，这一评估结果与根据 E/e' 标准 >15 评估的 DST 结果一致。

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An Increase in the Left Atrium Volume During Exercise is Associated With a Positive Result of a Diastolic Stress Test in Patients With Arterial Hypertension.

Aim: To study the relationship between changes in left atrial volume (LAV) during exercise and the result of a diastolic stress test (DST) in patients with arterial hypertension (AH).

Material and methods: The study included 219 patients with AH without ischemic heart disease and atrial fibrillation. During the DST performed before and after exercise, the ratio of transmitral flow velocity to mitral annular velocity (E/e'), the left atrial global longitudinal strain in the reservoir phase (reservoir strain), and LAV were determined. The criterion for a positive DST was an increase in E/e' ≥15.

Results: A positive result of DST was observed in 90 (41.1%) patients. Patients with positive DST were older (65.0 and 59.0 years); among them, there were fewer men (24.4 and 41.1%), but more patients with obesity (66.7 and 40.3%) and diabetes mellitus (36.7 and 8.5%). At rest, patients with positive DST had higher E/e' ratio (11.5 and 8.8), pulmonary artery systolic pressure (29.0 and 27.0 mm Hg), and LAV (60.0 and 52.0 ml), but a lower left atrial reservoir strain (20.0 and 24.0%). During exercise in patients with positive and negative DST, E/e' increased by 5.46 and 0.47 units, respectively. Changes in the LAV and reservoir strain during exercise in these groups were directed differently. In patients with positive DST, the left atrial reservoir strain decreased by 1.0 percentage points (pp) whereas in patients with negative DST, it increased by 8.0 pp. During exercise, the LAV increased by 10.0 ml in patients with a positive DST, whereas in the alternative group, the LAV decreased by 8.5 ml. The AUC for changes in LAV as an indicator of a positive DST was 0.987 while the AUC for the resting left atrial reservoir strain was 0.938. An increase in LAV >1 ml, as an indicator of a positive DST has a sensitivity of 96.9% and a specificity of 95.1%.

Conclusion: In AH patients, changes in left ventricular filling pressure are associated with a unidirectional change in LAV. An increase in LAV during exercise by more than 1 ml can serve as a criterion for a positive DST result. This assessment was consistent with the assessment of the DST result by the E/e' criterion >15 in 94.5% of cases.

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来源期刊

Kardiologiya 医学-心血管系统

CiteScore

1.70

自引率

20.00%

发文量

审稿时长

3-8 weeks

期刊介绍： “Kardiologiya” (Cardiology) is a monthly scientific, peer-reviewed journal committed to both basic cardiovascular medicine and practical aspects of cardiology. As the leader in its field, “Kardiologiya” provides original coverage of recent progress in cardiovascular medicine. We publish state-of-the-art articles integrating clinical and research activities in the fields of basic cardiovascular science and clinical cardiology, with a focus on emerging issues in cardiovascular disease. Our target audience spans a diversity of health care professionals and medical researchers working in cardiovascular medicine and related fields. The principal language of the Journal is Russian, an additional language – English (title, authors’ information, abstract, keywords). “Kardiologiya” is a peer-reviewed scientific journal. All articles are reviewed by scientists, who gained high international prestige in cardiovascular science and clinical cardiology. The Journal is currently cited and indexed in major Abstracting & Indexing databases: Web of Science, Medline and Scopus. The Journal''s primary objectives Contribute to raising the professional level of medical researchers, physicians and academic teachers. Present the results of current research and clinical observations, explore the effectiveness of drug and non-drug treatments of heart disease, inform about new diagnostic techniques; discuss current trends and new advancements in clinical cardiology, contribute to continuing medical education, inform readers about results of Russian and international scientific forums; Further improve the general quality of reviewing and editing of manuscripts submitted for publication; Provide the widest possible dissemination of the published articles, among the global scientific community; Extend distribution and indexing of scientific publications in major Abstracting & Indexing databases.