一种用于估计肺动脉高压患者肺血管阻力的新型非侵入性方法。
A novel non-invasive method of estimating pulmonary vascular resistance in patients with pulmonary arterial hypertension.
作者信息
Haddad François, Zamanian Roham, Beraud Anne-Sophie, Schnittger Ingela, Feinstein Jeffrey, Peterson Tyler, Yang Phil, Doyle Ramona, Rosenthal David
机构信息
Stanford University, Division of Cardiovascular Medicine, Palo Alto, CA 94304-5715, USA.
出版信息
J Am Soc Echocardiogr. 2009 May;22(5):523-9. doi: 10.1016/j.echo.2009.01.021.
BACKGROUND
The assessment of pulmonary vascular resistance (PVR) plays an important role in the diagnosis and management of pulmonary arterial hypertension (PAH). The main objective of this study was to determine whether the noninvasive index of systolic pulmonary arterial pressure (SPAP) to heart rate (HR) times the right ventricular outflow tract time-velocity integral (TVI(RVOT)) (SPAP/[HR x TVI(RVOT)]) provides clinically useful estimations of PVR in PAH.
METHODS
Doppler echocardiography and right-heart catheterization were performed in 51 consecutive patients with established PAH. The ratio of SPAP/(HR x TVI(RVOT)) was then correlated with invasive indexed PVR (PVRI) using regression and Bland-Altman analysis. Using receiver operating characteristic curve analysis, a cutoff value for the Doppler equation was generated to identify patients with PVRI > or = 15 Wood units (WU)/m2.
RESULTS
The mean pulmonary arterial pressure was 52 +/- 15 mm Hg, the mean cardiac index was 2.2 +/- 0.6 L/min/m2, and the mean PVRI was 20.5 +/- 9.6 WU/m2. The ratio of SPAP/(HR x TVI(RVOT)) correlated very well with invasive PVRI measurements (r = 0.860; 95% confidence interval, 0.759-0.920). A cutoff value of 0.076 provided well-balanced sensitivity (86%) and specificity (82%) to determine PVRI > 15 WU/m2. A cutoff value of 0.057 increased sensitivity to 97% and decreased specificity to 65%.
CONCLUSION
The novel index of SPAP/(HR x TVI(RVOT)) provides useful estimations of PVRI in patients with PAH.
背景
肺血管阻力（PVR）评估在肺动脉高压（PAH）的诊断和管理中起着重要作用。本研究的主要目的是确定收缩期肺动脉压（SPAP）与心率（HR）乘以右心室流出道时间速度积分（TVI(RVOT)）的无创指数（SPAP/[HR×TVI(RVOT)]）是否能为PAH患者的PVR提供临床有用的估计值。
方法
对51例确诊的PAH患者进行了多普勒超声心动图和右心导管检查。然后使用回归分析和布兰德-奥特曼分析，将SPAP/(HR×TVI(RVOT))比值与有创指数化PVR（PVRI）进行相关性分析。使用受试者工作特征曲线分析，得出多普勒方程的截断值，以识别PVRI≥15伍德单位（WU）/m²的患者。
结果
平均肺动脉压为52±15mmHg，平均心脏指数为2.2±0.6L/min/m²，平均PVRI为20.5±9.6WU/m²。SPAP/(HR×TVI(RVOT))比值与有创PVRI测量值相关性良好（r = 0.860；95%置信区间，0.759 - 0.920）。截断值为0.076时，在确定PVRI>15WU/m²方面具有良好的敏感性（86%）和特异性（82%）。截断值为0.057时，敏感性提高到97%，特异性降低到65%。
结论
SPAP/(HR×TVI(RVOT))这一新指数可为PAH患者的PVRI提供有用的估计值。
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