Melek Mehmet, Esen Ozlem, Esen Ali Metin, Barutcu Irfan, Fidan Fatma, Onrat Ersel, Kaya Dayimi
Department of Cardiology, School of Medicine, Kocatepe University, Afyon, Turkeye.
Lung. 2006 May-Jun;184(3):121-31. doi: 10.1007/s00408-005-2571-2.
Because transthoracic echocardiography is an inexpensive, easy, and reproducible method, it is the most commonly used noninvasive diagnostic tool to determine pulmonary artery pressure (PAP). Tissue Doppler imaging (TDI) emerged as a new echocardiographic method that can be applied in various clinical conditions. In our study we aimed to evaluate the relationship between tricuspid lateral annulus TDI parameters and pulmonary artery systolic pressure (PASP) as estimated by continuous wave Doppler in patients with chronic obstructive pulmonary disease (COPD). A total of 51 (42 men, mean age: 62.3 +/- 8.2 years) patients with clinically stable COPD were included in the study. The tricuspid annular systolic myocardial velocity (Sm), velocity time integral of Sm (SmVTI), early (Em) and late (Am) peak diastolic myocardial velocities, and myocardial isovolumic relaxation time (IVRTm) were acquired as well as two-dimensional (2-D) and conventional Doppler data. When compared with values of patients without pulmonary hypertension (PHT), Sm, SmVTI, Em, and Em/Am values were found to be lower and IVRTm values higher in patients with PHT. When all the patients were analyzed, there was a significant negative correlation between PASP and Sm and SmVTI (r = -0.82, p < 0.001 and r = -0.84, p < 0.001, respectively). Sm velocity < or = 12 cm/s had a sensitivity of 85% and a specificity of 93.3% for predicting PASP > 40 mmHg. SmVTI < or = 2.5 cm had a sensitivity of 85.7% and a specificity of 90% for detecting PHT. In our study, there was significant negative correlation between tricuspid lateral annular Sm and SmVTI values and PASP in patients with stable COPD irrespective of the presence of PHT. Tricuspid annular Sm and SmVTI had very good level sensitivity and specificity for predicting PHT. In conclusion, it might be suggested that in cases where noninvasive PASP measurement is not possible, TDI can be used as an alternative and reliable method to assess PAP.
由于经胸超声心动图是一种廉价、简便且可重复的方法，它是用于测定肺动脉压（PAP）最常用的非侵入性诊断工具。组织多普勒成像（TDI）作为一种可应用于各种临床情况的新型超声心动图方法应运而生。在我们的研究中，我们旨在评估慢性阻塞性肺疾病（COPD）患者中三尖瓣侧环TDI参数与连续波多普勒估计的肺动脉收缩压（PASP）之间的关系。共有51例（42名男性，平均年龄：62.3±8.2岁）临床稳定的COPD患者纳入研究。获取三尖瓣环收缩期心肌速度（Sm）、Sm的速度时间积分（SmVTI）、舒张早期（Em）和晚期（Am）峰值心肌速度以及心肌等容舒张时间（IVRTm）以及二维（2-D）和传统多普勒数据。与无肺动脉高压（PHT）患者的值相比，发现PHT患者的Sm、SmVTI、Em和Em/Am值较低，IVRTm值较高。对所有患者进行分析时，PASP与Sm和SmVTI之间存在显著负相关（r = -0.82，p < 0.001和r = -0.84，p < 0.001）。Sm速度≤12 cm/s预测PASP>40 mmHg的敏感性为85%，特异性为93.3%。SmVTI≤2.5 cm检测PHT的敏感性为85.7%，特异性为90%。在我们的研究中，无论是否存在PHT，稳定COPD患者三尖瓣侧环Sm和SmVTI值与PASP之间均存在显著负相关。三尖瓣环Sm和SmVTI对预测PHT具有非常好的敏感性和特异性。总之，可能有人建议，在无法进行非侵入性PASP测量的情况下，TDI可作为评估PAP的替代且可靠的方法。
