Nath Jayant, Demarco Teresa, Hourigan Lisa, Heidenreich Paul A, Foster Elyse
University of Kansas Medical Center, Kansas City, Kansas, USA.
Echocardiography. 2005 May;22(5):374-9. doi: 10.1111/j.1540-8175.2005.04022.x.
The aim of this study was to evaluate which parameter of right ventricular (RV) echocardiographic best mirrors the clinical status of patients with pulmonary arterial hypertension. Patients with pulmonary arterial hypertension on epoprostenol therapy were identified via hospital registry. Twenty patients, (16 females, 4 males) were included in the study, 9 with primary pulmonary hypertension and 11 with other diseases. Echocardiograms before therapy and at 22.7 (+/-9.3) months into therapy were compared. The right ventricular myocardial performance index (RVMPI) was measured as the sum of the isometric contraction time and the isometric relaxation time divided by right ventricular ejection time. Other measures included peak tricuspid regurgitation jet velocity (TRV), pulmonary artery systolic pressure (PASP), pulmonary valve velocity time integral (PVVTI), PASP/PVVTI (as an index of total pulmonary resistance) and symptoms by New York Heart Association (NYHA) functional class. Echo parameters of right ventricular function were analyzed in patients, before and during therapy. There was significant improvement of NYHA class in patients following epoprostenol therapy (P < 0.0001). Peak tricuspid regurgitant jet velocity (pre 4.2 +/- 0.6 m/sec, post 3.8 +/- 0.7 m/sec, P = 0.02) and PASP/PVVTI (pre 6.7 +/- 3.3 mmHg/m per second, post 4.8 +/- 2.2 mmHg/m per second, P < 0.0001) were significantly improved during treatment. RVMPI did not improve (pre 0.6 +/- 0.3, post 0.6 +/- 0.3, P = 0.54). Changes in NYHA class did not correlate with changes in RVMPI (P = 0.33) or changes in PASP/PVVTI (P = 0.58). Despite significant improvements in TRV, PASP/PVVTI, and NYHA class, there was no significant change in RVMPI on epoprostenol therapy. Changes in right ventricular indices were not correlated with changes in NYHA class.
本研究的目的是评估右心室超声心动图的哪个参数最能反映肺动脉高压患者的临床状况。通过医院登记系统确定接受依前列醇治疗的肺动脉高压患者。20名患者（16名女性，4名男性）被纳入研究，其中9例为原发性肺动脉高压，11例患有其他疾病。比较治疗前和治疗22.7（±9.3）个月时的超声心动图。右心室心肌做功指数（RVMPI）通过等容收缩时间与等容舒张时间之和除以右心室射血时间来测量。其他测量指标包括三尖瓣反流峰值流速（TRV）、肺动脉收缩压（PASP）、肺动脉瓣流速时间积分（PVVTI）、PASP/PVVTI（作为总肺阻力的指标）以及纽约心脏协会（NYHA）功能分级的症状。对患者治疗前和治疗期间的右心室功能回声参数进行分析。依前列醇治疗后患者的NYHA分级有显著改善（P < 0.0001）。治疗期间，三尖瓣反流峰值流速（治疗前4.2±0.6米/秒，治疗后3.8±0.7米/秒，P = 0.02）和PASP/PVVTI（治疗前6.7±3.3毫米汞柱/米每秒，治疗后4.8±2.2毫米汞柱/米每秒，P < 0.0001）有显著改善。RVMPI没有改善（治疗前0.6±0.3，治疗后0.6±0.3，P = 0.54）。NYHA分级的变化与RVMPI的变化（P = 0.33）或PASP/PVVTI的变化（P = 0.58）无关。尽管TRV、PASP/PVVTI和NYHA分级有显著改善，但依前列醇治疗对RVMPI没有显著影响。右心室指标的变化与NYHA分级的变化无关。
