Apport de l’échocardiographie Doppler dans le diagnostic de l’insuffisance cardiaque aiguë à fonction systolique conservée du sujet âgé

Abstract

Purpose: To evaluate the clinical usefulness of the determination of Doppler mitral inflow pattern and new combined indices using colour M mode velocity flow propagation (Vp) in the diagnosis of acute diastolic heart failure in the elderly. Methods: Total serum protein concentration (P, g/l) and E/A, E/Vp and 1000/(2 × IRT + Vp) Doppler indices (E and A: mitral inflow peak velocities ; IRT : isovolumic relaxation time) were measured at the time of therapy initiation in 94 patients with left ventricular ejection fraction > 50% (78 ± 13 years), 56 with pulmonary edema and 38 patients with acute respiratory disease. Results: The feasibility was 73, 90 and 89% for E/A, E/Vp and 1000/(2 × IRT + Vp) respectively. The sensitivity, specificity and accuracy were 94–56–72%, 84–86–85% and 92–86–89% for E/A ≥ 1, E/Vp ≥ 2 and 1000/(2 × IRT + Vp) ≥ 6 respectively in the diagnosis of pulmonary edema in patients with normal serum colloid osmotic pressure defined by P ≥ 60g/l, and 41–50–43%, 37–86–50% and 22–100–42% in patients with low colloid osmotic pressure ( P < 60g/l). Conclusions: The mitral inflow measurement is limited in most of cases of acute diastolic heart failure in the elderly by confounding factors such as atrial fibrillation and normalised pattern. New combined Doppler indices are useful in these patients, however, their value must be interpreted according to the serum colloid osmotic status estimated by total serum protein concentration.