Selimovic Nedim, Rundqvist Bengt, Bergh Claes-Hakan, Andersson Bert, Petersson Sofia, Johansson Lena, Bech-Hanssen Odd
Department of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden.
J Heart Lung Transplant. 2007 Sep;26(9):927-34. doi: 10.1016/j.healun.2007.06.008.
Assessment of pulmonary artery pressures, cardiac output (CO) and pulmonary vascular resistance (PVR) is crucial in the management of patients with pulmonary arterial hypertension (PAH). The aim of the present study was to investigate whether Doppler echocardiography can be used to determine PVR in patients with PAH.
Forty-two patients were included and Doppler echocardiography was performed simultaneously (n = 22) and non-simultaneously (n = 60) with right heart catheterization. The tricuspid regurgitation velocity was used to estimate pulmonary arterial peak systolic and diastolic (PADP) pressures (Bernoulli equation). At the time of pulmonary valve opening, right ventricular pressure equals PADP. The tricuspid regurgitation velocity at the time of pulmonary valve opening was measured by superimposing the time from the QRS to the onset of pulmonary flow on the tricuspid regurgitation velocity envelope. Pulmonary capillary wedge pressure, right atrial pressure and CO were assessed using standard Doppler echocardiography methods. Right heart catheterization was performed using Swan-Ganz catheters and thermodilution for CO determination.
The differences (mean +/- SD) between catheter and simultaneous/non-simultaneous Doppler echocardiography were 0.3 +/- 0.8 (p = 0.10)/-0.3 +/- 1.1 (p = 0.06) liter/min for CO, 2.9 +/- 5.1 (p = 0.02)/-1.2 +/- 7.4 (p = 0.2) mm Hg for the transpulmonary gradient (TPG) and 0.3 +/- 2.1 (p = 0.65)/0.8 +/- 2.4 (p = 0.02) Wood unit for PVR. The correlation coefficients between catheter and simultaneous/non-simultaneous Doppler echocardiography were 0.86/0.75 for CO, 0.92/0.90 for TPG and 0.93/0.92 for PVR.
A comprehensive hemodynamic assessment that includes CO, TPG and PVR can be provided by Doppler echocardiography in patients with severe pulmonary hypertension.
评估肺动脉压、心输出量（CO）和肺血管阻力（PVR）对肺动脉高压（PAH）患者的管理至关重要。本研究的目的是调查多普勒超声心动图是否可用于测定PAH患者的PVR。
纳入42例患者，分别同时（n = 22）和非同时（n = 60）进行多普勒超声心动图检查及右心导管检查。利用三尖瓣反流速度估算肺动脉收缩压峰值和舒张压（PADP）（伯努利方程）。在肺动脉瓣开放时，右心室压力等于PADP。通过将从QRS波到肺血流开始的时间叠加到三尖瓣反流速度包络线上，测量肺动脉瓣开放时的三尖瓣反流速度。使用标准多普勒超声心动图方法评估肺毛细血管楔压、右心房压力和CO。采用Swan - Ganz导管进行右心导管检查，并通过热稀释法测定CO。
导管检查与同时/非同时多普勒超声心动图检查在CO方面的差异（均值±标准差）为0.3±0.8（p = 0.10）/ - 0.3±1.1（p = 0.06）升/分钟，跨肺压差（TPG）方面为2.9±5.1（p = 0.02）/ - 1.2±7.4（p = 0.2）毫米汞柱，PVR方面为0.3±2.1（p = 0.65）/ 0.8±2.4（p = 0.02）伍德单位。导管检查与同时/非同时多普勒超声心动图检查在CO方面的相关系数分别为0.86/0.75，TPG方面为0.92/0.90，PVR方面为0.93/0.92。
多普勒超声心动图可为重度肺动脉高压患者提供包括CO、TPG和PVR在内的全面血流动力学评估。
