Bréchot Nicolas, Gambotti Laetitia, Lafitte Stéphane, Roudaut Raymond
Department of Cardiology, University Hospital of Bordeaux-Pessac, Bordeaux-Pessac, France.
Eur J Echocardiogr. 2008 Jul;9(4):547-54. doi: 10.1093/ejechocard/jen121. Epub 2008 Mar 14.
Systolic pulmonary artery pressure (sPAP) cannot always be assessed from Doppler-detected tricuspid regurgitation (TR), especially when sPAP is normal. The right ventricular isovolumic relaxation time (rIVRT) is related to sPAP, and assessment of rIVRT by tissular Doppler imaging (rIVRT') has recently been proposed as an alternative method for estimating sPAP in patients with pulmonary artery hypertension (PAH). We evaluated here its usefulness in everyday clinical practice.
We conducted a prospective Doppler vs. catheterization study in 26 patients. TR was undetectable in 6 patients (32%) with normal sPAP and in one patient (14%) from those with PAH. rIVRT' was recordable in all patients. We found a strong correlation between rIVRT' and sPAP (r = 0.87; P < 0.0001). rIVRT' had a high sensitivity in detecting PAH, and a rIVRT' of 40 ms or less excluded PAH with a negative predictive value of 100%. We also found that a prolonged rIVRT' is not specific to PAH and that the rIVRT'-evaluated sPAP did not agree well with the catheter-evaluated value.
Measurement of rIVRT' can help estimate sPAP in the absence of TR: A normal rIVRT' excludes PAH with a high negative predictive value. A prolonged rIVRT' is in favour of an elevated sPAP but cannot affirm it by itself.
收缩期肺动脉压（sPAP）并非总能通过多普勒检测到的三尖瓣反流（TR）来评估，尤其是当sPAP正常时。右心室等容舒张时间（rIVRT）与sPAP相关，最近有人提出通过组织多普勒成像评估rIVRT（rIVRT'）作为估计肺动脉高压（PAH）患者sPAP的替代方法。我们在此评估其在日常临床实践中的实用性。
我们对26例患者进行了一项前瞻性多普勒与导管检查对比研究。在6例（32%）sPAP正常的患者和1例（14%）PAH患者中未检测到TR。所有患者均可记录rIVRT'。我们发现rIVRT'与sPAP之间存在强相关性（r = 0.87；P < 0.0001）。rIVRT'在检测PAH方面具有高敏感性，rIVRT'≤40 ms可排除PAH，阴性预测值为100%。我们还发现rIVRT'延长并非PAH所特有，且通过rIVRT'评估的sPAP与导管评估值不太一致。
在没有TR的情况下，测量rIVRT'有助于估计sPAP：正常的rIVRT'以高阴性预测值排除PAH。rIVRT'延长提示sPAP升高，但仅凭此不能确诊。
