| Title: | Simple Two-Dimensional Echocardiographic Scoring System for the Estimation of Left Ventricular Filling Pressure |
| Authors: | Murayama, Michito Browse this author |
| Iwano, Hiroyuki Browse this author |
| Nishino, Hisao Browse this author |
| Tsujinaga, Shingo Browse this author |
| Nakabachi, Masahiro Browse this author |
| Yokoyama, Shinobu Browse this author |
| Aiba, Miho Browse this author |
| Okada, Kazunori Browse this author |
| Kaga, Sanae Browse this author |
| Sarashina, Miwa Browse this author |
| Chiba, Yasuyuki Browse this author |
| Ishizaka, Suguru Browse this author |
| Motoi, Ko Browse this author |
| Nishida, Mutsumi Browse this author |
| Shibuya, Hitoshi Browse this author |
| Kamiya, Kiwamu Browse this author |
| Nagai, Toshiyuki Browse this author |
| Anzai, Toshihisa Browse this author →KAKEN DB |
| Keywords: | Echocardiography |
| Pathophysiology |
| Heart failure |
| Left ventricular filling pressure |
| Predictive ability |
| Issue Date: | Jul-2021 |
| Publisher: | Elsevier |
| Journal Title: | Journal of the American Society of Echocardiography |
| Volume: | 34 |
| Issue: | 7 |
| Start Page: | 723 |
| End Page: | 734 |
| Publisher DOI: | 10.1016/j.echo.2021.02.013 |
| Abstract: | Background: When left ventricular filling pressure (LVFP) increases, the mitral valve opens early and precedes tricuspid valve opening in early diastole. The authors hypothesized that a visually assessed time sequence of atrioventricular valve opening could become a new marker of elevated LVFP. The aim of this study was to test the diagnostic ability of a novel echocardiographic scoring system, the visually assessed time difference between mitral valve and tricuspid valve opening (VMT) score, in patients with heart failure. Methods: One hundred nineteen consecutive patients who underwent cardiac catheterization within 24 hours of echocardiographic examination were retrospectively analyzed as a derivation cohort. In addition, a prospective study was conducted to validate the diagnostic ability of the VMT score in 50 patients. Elevated LVFP was defined as mean pulmonary artery wedge pressure (PAWP) >_ 15 mm Hg. The time sequence of atrioventricular valve opening was visually assessed and scored (0 = tricuspid valve first, 1 = simultaneous, 2 = mitral valve first). When the inferior vena cava was dilated, 1 point was added, and VMT score was ultimately graded as 0 to 3. Cardiac events were recorded for 1 year after echocardiography. Results: In the derivation cohort, PAWP was elevated with higher VMT scores (score 0,10 +/- 5; score 1,12 +/- 4; score 2, 22 +/- 8; score 3, 28 +/- 4 mm Hg; P < .001, analysis of variance). VMT score >_ 2 predicted elevated PAWP with accuracy of 86% and showed incremental predictive value over clinical variables and guideline recommended diastolic function grading. These observations were confirmed in the prospective validation cohort. Importantly, VMT score >_ 2 discriminated elevated PAWP with accuracy of 82% in 33 patients with monophasic left ventricular inflow in the derivation cohort. Kaplan-Meier analysis demonstrated that patients with VMT scores >_ 2 were at higher risk for cardiac events than those with VMT scores # 1 (P < .001). Conclusions: VMT scoring could be a novel additive marker of elevated LVFP and might also be associated with adverse outcomes in patients with heart failure. |
| Type: | article |
| URI: | http://hdl.handle.net/2115/82530 |
| Appears in Collections: | 医学院・医学研究院 (Graduate School of Medicine / Faculty of Medicine) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)
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