射血分数保留心力衰竭不同诊断标准价值的比较

发布时间：2018-10-08 16:42

【摘要】：目的探讨包括替代标准在内的四项射血分数保留的心力衰竭(简称心衰)诊断标准对急性呼吸困难入院患者的诊断价值。方法选取2012年6月至2013年8月因呼吸困难于大连医科大学附属第一医院心内科因呼吸困难住院患者111例,分射血分数保留的心衰组(71例)和对照组(40例),测超声心动图、B型钠尿肽等指标。比较各参数以及2012欧洲心脏学会(ESC)心衰指南、2009欧洲超声心动杂志(EAE/ASE)左室舒张功能建议、2010替代标准和改良标准的价值。结果二尖瓣舒张早期流速与侧壁瓣环组织多普勒速度比值(AUC=0.77)、B型钠尿肽(AUC=0.78)、左房容积指数(AUC=0.73)、左室质量指数(AUC=0.67)和肺静脉心房收缩血流与二尖瓣心房收缩持续时间差(AUC=0.69)的诊断效果最好。与金标准比,替代标准一致性最差(Kappa=0.13,P=0.063),诊断准确率50.5%;2012ESC指南最好(Kappa=0.62,P0.001),准确率82%;将左房容积指数和B型钠尿肽引入替代标准建立改良标准,Kappa=0.47(P0.001),准确率73.9%。结论替代标准不适于基层医疗机构诊断射血分数保留心衰,改良标准可能更好。
[Abstract]:Objective to investigate the diagnostic value of four diagnostic criteria for heart failure (HF) including replacement criteria in patients with acute dyspnea. Methods 111 inpatients with dyspnea from June 2012 to August 2013 in Department of Cardiology, the first affiliated Hospital of Dalian Medical University, were selected. The indexes of B-type natriuretic peptide were measured by echocardiography in 71 cases of heart failure group and 40 cases of control group. To compare the parameters and the value of the 2012 European Heart Association (ESC) guidelines for Heart failure and the European Journal of Echocardiography (EAE/ASE) in suggesting left Ventricular diastolic function for the 2010 alternative and improved criteria. Results early diastolic velocities of mitral valve and Doppler velocity ratio of lateral annulus (AUC=0.77), B-type natriuretic peptide (AUC=0.78), left atrial volume index (AUC=0.73), left ventricular mass index (AUC=0.67) and the difference between atrial systolic flow of pulmonary vein and duration of mitral atrial contraction (AUC=0.69) were the best. Compared with the gold standard, the consistency of the substitution standard (Kappa=0.13,P=0.063) was the worst, the diagnostic accuracy was 50.5%, and the accuracy was 82.The left atrial volume index and B-type natriuretic peptide were introduced into the substitute standard to establish the improved standard Kappa 0.47 (P0.001), and the accuracy rate was 73.9%. Conclusion the replacement standard is not suitable for primary medical institutions in the diagnosis of ejection fraction retained heart failure, and the improved standard may be better.
【作者单位】：大连医科大学附属第一医院心内科;
【基金】：辽宁省科技计划资助项目(201222520) 大连市科技计划资助项目(2014E14SF173)
【分类号】：R541.6

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