Banerjee S K, Ahmed C M, Rahman M A, Hossain M, Mahmud R S, Khan H I L R, Haque K M H S
Bangabandhu Sheikh Mujib Medical University.
Bangladesh Med Res Counc Bull. 2003 Dec;29(3):92-102.
Non invasive estimation of pulmonary artery pressure (PAP) is of paramount importance in various form of cardiac, respiratory and intensive care medicine practice. Using pressure gradient between different chambers enables a reliable estimation of PAP and are being largely practiced. In absence of these pressure gradient, various time interval or the ratios of pulmonary blood flow velocity curve (PBFVC) in pulsed wave doppler echocardiography (PWDE) can predict the PAP. But there is lack of general agreement as which parameter should be used. We hypothesized that using separate time interval or their ratios of PBFVC for different group of patient may improve the PWDE prediction of PAP. Forty-six consecutive patients with different cardiac diseases and 20 consecutive control persons underwent PWD echocardiographic examination. Pulmonary blood flow velocity curve derived time intervals--the time intervals--time to peak velocity (TPV), Pre-ejection period (PEP) and right ventricular ejection time (RVET) and their ratios were measured. The Doppler derived measurements were compared with cardiac catheterization (CC) measured PAP in 46 patients in whom CC were done. PBFVC derived time interval TPV and the ratio PEP/TPV correlated well with CC measured systolic PAP (r=-0.78 and r=0.77 respectively). For congenital left to right shunt disease the ratio PEP/TPV improved the prediction (r=-0.87) while the same measure showed weak correlation in patients with left sided heart disease. Only TPV could predict mean PAP in patients with left sided heart disease (r=-0.60). We concluded that the use of separate PBFVC derived time interval or their ratio from PWDE may improve the prediction of PAP with different pathological group of disease.
无创估计肺动脉压（PAP）在各种形式的心脏、呼吸和重症监护医学实践中至关重要。利用不同心腔之间的压力梯度能够可靠地估计肺动脉压，并且目前广泛应用。在缺乏这些压力梯度的情况下，脉冲波多普勒超声心动图（PWDE）中肺血流速度曲线（PBFVC）的各种时间间隔或比率可用于预测肺动脉压。但对于应使用哪个参数尚无普遍共识。我们假设，针对不同患者群体使用PBFVC单独的时间间隔或其比率可能会改善PWDE对肺动脉压的预测。46例连续的不同心脏病患者和20例连续的对照者接受了PWDE超声心动图检查。测量了肺血流速度曲线得出的时间间隔——达到峰值速度的时间（TPV）、射血前期（PEP）和右心室射血时间（RVET）及其比率。将46例进行了心导管检查（CC）的患者的多普勒测量值与CC测量的肺动脉压进行比较。PBFVC得出的时间间隔TPV和PEP/TPV比率与CC测量的收缩期肺动脉压相关性良好（分别为r = -0.78和r = 0.77）。对于先天性左向右分流疾病，PEP/TPV比率改善了预测效果（r = -0.87），而在左侧心脏病患者中该指标显示出较弱的相关性。仅TPV能够预测左侧心脏病患者的平均肺动脉压（r = -0.60）。我们得出结论，使用PWDE中PBFVC单独的时间间隔或其比率可能会改善对不同病理疾病组肺动脉压的预测。
