电子心力测量法对成人心力衰竭的诊断价值研究

Value of electrical cardiometry in the diagnosis of heart failure in adults

摘要

目的：探讨无创血流动力学检测技术中的电子心力测量（electrical cardiometry,EC）法对成人心力衰竭（heart failure,HF）的诊断价值。方法：选择2022年9月至2024年5月重庆医科大学附属第一医院心血管内科住院成人患者进行前瞻性研究，将临床诊断为HF的患者纳入HF组，临床排除HF的患者纳入对照组。比较2组EC法测定的每搏输出变异（stroke volume variation,SVV）、收缩时间比例（systolic time ratio,STR）、预射血前期（pre-ejection period,PEP）、心肌收缩指数（contractility,ICON）、心肌收缩指数变异（ICON Variation,VIC）、左心室射血时间（left ventricle ejection time,LVET）、左心室射血分数（left ventricular ejection fraction,LVEF）及一般临床资料。采用前进法构建多因素logistic回归模型分析HF的相关因素。进一步绘制EC法测定的血流动力学指标诊断HF的受试者工作特征（receiver operating characteristic,ROC）曲线，计算曲线下面积（area under the curve,AUC）。结果：共纳入239例，其中HF组126例，对照组113例。HF组SVV、STR、PEP、VIC、年龄高于对照组，ICON、LVET、LVEF低于对照组（P<0.001）。采用前进法构建多因素logistic回归模型结果显示，STR(OR=1.199,95%CI=1.110～1.294,P<0.001)、VIC(OR=1.176,95%CI=1.090～1.269,P<0.001)、年龄（OR=1.068,95%CI=1.010～1.128,P<0.05）与HF呈正相关。ICON(OR=0.968,95%CI=0.941～0.996,P<0.05)、LVEF(OR=0.854,95%CI=0.798～0.913,P<0.001)与HF呈负相关。ROC曲线显示STR、VIC、ICON诊断HF的AUC分别为0.887(95%CI=0.848～0.927)、0.891(95%CI=0.851～0.932)、0.718(95%CI=0.654～0.782)；最佳临界值分别为37.5%、19.5%、49.3；灵敏度依次为91.3%、73.8%、50.0%，特异度依次为61.4%、93.8%、86.7%。其中，STR联合VIC诊断HF的AUC为0.940(95%CI=0.912～0.967)，灵敏度为83.3%，特异度为91.2%。结论：EC法可有效评估成人患者的心功能状态，STR联合VIC对于诊断HF有一定的临床价值。

Abstract

Objective To investigate the value of electrical cardiometry（EC），a noninvasive hemodynamic testing technique，in the diagnosis of heart failure（HF） in adults. Methods A prospective study was conducted among the adult patients who were hospitalized in Department of Cardiology，The First Affiliated Hospital of Chongqing Medical University，from September 2022 to May 2024，and the patients who were diagnosed with HF were enrolled as HF group，while those who were excluded from the clinical diagnosis of HF were enrolled as control group. The two groups were compared in terms of general clinical data and related parameters measured by EC，including stroke volume variation（SVV），systolic time ratio（STR），pre-ejection period（PEP），index of contractility（ICON），ICON variation（VIC），left ventricular ejection time（LVET），and left ventricular ejection fraction（LVEF）. A multivariate logistic regression model established by the forward method was used to investigate the factors associated with HF. The receiver operating characteristic （ROC） curve was plotted for the hemodynamic parameters measured by EC in the diagnosis of HF，and the area under the ROC curve （AUC） was calculated. Results A total of 239 patients were enrolled，with 126 in the HF group and 113 in the control group. Compared with the control group，the HF group had significantly higher SVV，STR，PEP，VIC，and age and significantly lower ICON，LVET，and LVEF（all P<0.001）. The multivariate logistic regression model established by the forward method showed that STR （odds ratio［OR］=1.199，95%CI=1.110-1.294，P<0.001），VIC（OR=1.176，95%CI=1.090-1.269，P<0.001），and age（OR=1.068，95%CI=1.010-1.128，P<0.05） were positively correlated with HF，and ICON（OR=0.968，95%CI=0.941-0.996，P<0.05） and LVEF（OR=0.854，95%CI=0.798-0.913，P<0.001） were negatively correlated with HF. The ROC curve analysis showed that STR，VIC，and ICON had an AUC of 0.887（95%CI=0.848-0.927），0.891（95%CI=0.851-0.932），and 0.718 （95%CI=0.654-0.782），respectively，in the diagnosis of HF，with an optimal cut-off value of 37.5%，19.5%，and 49.3，respectively，a sensitivity of 91.3%，73.8%，and 50.0%，respectively，and a specificity of 61.4%，93.8%，and 86.7%，respectively. Among these indicators，STR combined with VIC had an AUC of 0.940（95%CI=0.912-0.967） in the diagnosis of HF，with a sensitivity of 83.3% and a specificity of 91.2%. Conclusion The EC method can effectively assess the cardiac functional status of adult patients，and STR combined with VIC has some clinical value for the diagnosis of heart failure.

Graphical abstract

关键词

无创血流动力学检测技术 / 电子心力测量法 / 心力衰竭

Key words

noninvasive hemodynamic testing / electrical cardiometry / heart failure

基金资助

国家自然科学基金资助项目(CSTB2024NSCQ-MSX1071)