Gonzalez-Vilchez F, Ares M, Ayuela J, Alonso L
Cardiology Section, Service of Internal Medicine, Hospital General Yagüe, Burgos, Spain.
J Am Coll Cardiol. 1999 Aug;34(2):515-23. doi: 10.1016/s0735-1097(99)00230-2.
We sought a noninvasive estimation of pulmonary capillary wedge pressure (Pw) by means of the information obtained from transmitral pulsed Doppler and color M-mode Doppler flow propagation velocity (FPV).
Pulsed Doppler parameters have limited accuracy for the estimation of Pw because they are determined by left atrial pressure and other parameters such as ventricular relaxation. Recently, a good correlation has been found between the rate of ventricular relaxation (tau, tau) and FPV measured by color M-mode Doppler echocardiography.
We studied 20 patients who underwent invasive hemodynamic monitoring. By multilinear regression analysis, the relationships between Pw and Doppler parameters, FPV, and a noninvasive estimate (P(est)) based on the Weiss' equation (substituting tau for 1/FPV) were determined. A simplified index based on the results obtained was then tested in an additional group of 34 patients.
By multiple regression analysis only isovolumic relaxation time (IVRT) (p = 0.0096) and P(est) (p = 0.0043) were related to Pw. A derived empirical index, 10(3)/([2 x IVRT] + FPV), was strongly correlated with Pw in the entire group according to the regression equation Pw = 4.5 x (10(3)/[[2 x IVRT] + FPV]) - 9 (r = 0.89, p < 0.0001, [standard error of the estimate] SEE = 3.3 mm Hg). The sensitivity and specificity for the prediction of Pw > 15 mm Hg were 90% and 100%, respectively.
The combined use of FPV as a surrogate for tau and IVRT permits a close prediction of Pw.
我们试图通过经二尖瓣脉冲多普勒和彩色M型多普勒血流传播速度（FPV）获得的信息对肺毛细血管楔压（Pw）进行无创估计。
脉冲多普勒参数对Pw的估计准确性有限，因为它们由左心房压力和其他参数（如心室舒张）决定。最近，通过彩色M型多普勒超声心动图测量发现心室舒张速率（tau，τ）与FPV之间存在良好的相关性。
我们研究了20例接受有创血流动力学监测的患者。通过多线性回归分析，确定了Pw与多普勒参数、FPV以及基于韦斯方程（用tau代替1/FPV）的无创估计值（P(est)）之间的关系。然后在另外34例患者组成的组中对基于所得结果的简化指数进行了测试。
通过多元回归分析，仅等容舒张时间（IVRT）（p = 0.0096）和P(est)（p = 0.0043）与Pw相关。根据回归方程Pw = 4.5×(10³/[[2×IVRT] + FPV]) - 9（r = 0.89，p < 0.0001，估计标准误差SEE = 3.3 mmHg），一个推导的经验指数10³/([2×IVRT] + FPV)在整个组中与Pw密切相关。预测Pw > 15 mmHg的敏感性和特异性分别为90%和100%。
联合使用FPV作为tau的替代指标和IVRT可实现对Pw的精确预测。
