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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,P<0.001),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(P<0.001),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。
Objective To investigate the diagnostic value of four diagnostic criteria for heart failure (referred to as heart failure) including ejection fraction retention criteria for patients admitted to hospital with acute dyspnea. Methods A total of 111 hospitalized patients with respiratory distress due to dyspnea at Cardiology Department of Dalian Medical University from June 2012 to August 2013 were enrolled in this study. Heart failure patients (71 cases) with preserved ejection fraction and control group (40 cases) Cases), measured echocardiography, B-type natriuretic peptide and other indicators. The parameters and values of the 2012 European Heart Association (ESC) guidelines for heart failure, the 2009 recommendations for left ventricular diastolic function in the European Society for Echocardiography (EAE / ASE), 2010 Alternatives, and Modified Standards were compared. Results The ratio of mitral early diastolic velocity to Doppler velocity of lateral annulus (AUC = 0.77), B type natriuretic peptide (AUC = 0.78), left atrium volume index (AUC = 0.73), left ventricular mass index AUC = 0.67) and pulmonary venous atrial contraction flow and mitral atrial contraction duration (AUC = 0.69) the best diagnosis. (Kappa = 0.13, P = 0.063), the diagnostic accuracy rate was 50.5%; the guideline of 2012 ESC was the best (Kappa = 0.62, P <0.001), the accuracy was 82%; the left atrial volume Index and B-type natriuretic peptide introduced an alternative standard to establish a modified standard with Kappa = 0.47 (P <0.001) with an accuracy of 73.9%. Conclusion The alternative standard is not suitable for primary health care institutions to maintain ejection fraction of heart failure, the improvement of the standard may be better.