Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan.
J Am Soc Echocardiogr. 2009 Dec;22(12):1368-74. doi: 10.1016/j.echo.2009.08.023.
Right ventricular (RV) filling pressure can be estimated using tissue Doppler imaging (TDI) from the tricuspid lateral annulus, but few data are available on the usefulness of Doppler-derived RV filling pressure in predicting the prognosis of chronic pulmonary arterial hypertension (PAH).
In 50 consecutive patients with PAH, TDI was performed within 24 hours of right-sided catheterization to measure early diastolic myocardial velocity at the tricuspid lateral annulus (E(a)) and early diastolic tricuspid inflow (E). The tricuspid E/E(a) ratio was calculated and compared with the invasive hemodynamic variables. Cardiac events were defined as cardiac death or rehospitalization due to RV failure.
Mean right atrial pressure (RAP) averaged 6 +/- 5 mm Hg (range, 1-25 mm Hg). E/E(a) correlated positively with mean RAP (r = 0.80, P < .001), irrespective of RV systolic function. We divided patients into group A with cardiac events (n = 19) and group B without events (n = 31) in a mean follow-up period of 14 months. Plasma brain natriuretic peptide level and E/E(a) were significantly higher in group A than in group B (349 +/- 310 pg/dL vs 129 +/- 136 pg/dL, P = .001; 7.0 +/- 3.2 vs 4.5 +/- 1.9, P = .004, respectively), whereas mean pulmonary artery pressure did not differ significantly. In a multivariate model, E/E(a) remained predictive for cardiac events (hazard ratio 1.227; 95% confidence interval, 1.042-1.444; P = .014). An E/E(a) cutoff value of 6.8 discriminated cases with cardiac events with a sensitivity of 42% and specificity of 97% (area under the curve 0.71).
The tricuspid E/E(a) ratio provides a reliable estimation of RV filling pressure and predicts cardiac events in patients with PAH.
右心室（RV）充盈压可以通过组织多普勒成像（TDI）从三尖瓣外侧环来估计，但关于多普勒衍生的 RV 充盈压在预测慢性肺动脉高压（PAH）预后中的有用性的数据很少。
在 50 例连续的 PAH 患者中，在右侧心导管插入术的 24 小时内进行 TDI，以测量三尖瓣外侧环的舒张早期心肌速度（Ea）和舒张早期三尖瓣流入（E）。计算三尖瓣 E/Ea 比值，并与侵入性血流动力学变量进行比较。心脏事件定义为心脏死亡或因 RV 衰竭而再入院。
平均右心房压（RAP）为 6±5mmHg（范围，1-25mmHg）。E/Ea 与平均 RAP 呈正相关（r=0.80，P<.001），与 RV 收缩功能无关。我们将患者分为有心脏事件的 A 组（n=19）和无事件的 B 组（n=31），平均随访 14 个月。在 A 组中，血浆脑钠肽水平和 E/Ea 显著高于 B 组（349±310pg/dL 与 129±136pg/dL，P=0.001；7.0±3.2 与 4.5±1.9，P=0.004），而平均肺动脉压无显著差异。在多变量模型中，E/Ea 仍然是心脏事件的预测因素（危险比 1.227；95%置信区间，1.042-1.444；P=0.014）。E/Ea 截断值为 6.8 时，对心脏事件的敏感性为 42%，特异性为 97%（曲线下面积 0.71）。
三尖瓣 E/Ea 比值可可靠估计 RV 充盈压，并预测 PAH 患者的心脏事件。
