Kingston Heart Clinic, 460 Princess Street, Kingston, Ontario, Canada.
Can J Cardiol. 2010 Feb;26(2):e35-9. doi: 10.1016/s0828-282x(10)70004-0.
Previous studies have shown that in the absence of underlying cardiac pathology, the echocardiographic estimate of right ventricular systolic pressure (RVSP) increases progressively and normally with age. There are limited data in patients older than 60 years of age.
To define the ranges of RVSP according to age and to include more elderly patients than have previously been reported.
All patients undergoing echocardiography since May 26, 1999, at the Kingston Heart Clinic (Kingston, Ontario) have had their data entered into a locally designed cardiology database (CARDIOfile; Registered trademark, Kingston Heart Clinic). RVSP was calculated from the peak tricuspid regurgitant jet velocity (V) using the modified Bernoulli equation (RVSP = 4V2 + RAP), with the mean right atrial pressure (RAP) estimated to be 10 mmHg. Of the 22,628 patients who had undergone echocardiography, 10,905 had RVSP measured. All abnormal echocardiograms were excluded, leaving 1559 echocardiograms for analysis.
Patient age ranged from 15 to 93 years. The mean age was 49 years. RVSP increased significantly only after the age of 50 years. The mean (+/- SD) RVSP for those younger than 50 years, 50 to 75 years, and older than 75 years of age was 27.3+/-5.7 mmHg, 30.2+/-7.6 mmHg and 34.8+/-8.7 mmHg, respectively (P<0.0001 among all age groups). The normal range (95% CI) of RVSP in those younger than 50 years, 50 to 75 years, and older than 75 years of age was 16 mmHg to 39 mmHg, 15 mmHg to 45 mmHg, and 17 mmHg to 52 mmHg, respectively. Multivariate analysis indicated that age, mitral diastolic early-to-late filling velocity ratio, ejection fraction, aortic size and early mitral filling velocity/ early diastolic mitral annular velocity were the only significant independent variables. There were significant changes in diastolic function with increasing age, which may have been responsible for the changes in RVSP.
RVSP remains stable in both men and women until the age of 50 years. Thereafter, RVSP increases progressively in a linear manner with age and is significantly higher in patients older than 75 years of age. The changes may relate to changes in diastolic function. These ranges should be taken into account when using echocardiogram-derived RVSP for the diagnosis of pulmonary hypertension in the absence of cardiovascular disease.
先前的研究表明，在不存在潜在心脏病理学的情况下，右心室收缩压（RVSP）的超声心动图估计值随年龄呈渐进性正常增加。在年龄超过 60 岁的患者中，数据有限。
根据年龄定义 RVSP 的范围，并纳入比以往报告更多的老年患者。
自 1999 年 5 月 26 日以来，在金斯敦心脏诊所（安大略省金斯敦）接受超声心动图检查的所有患者，其数据均已输入本地设计的心脏病学数据库（CARDIOfile；注册商标，金斯敦心脏诊所）。使用改良伯努利方程（RVSP=4V2+RAP）从三尖瓣反流射流速度（V）计算 RVSP，其中平均右心房压（RAP）估计为 10mmHg。在接受超声心动图检查的 22628 名患者中，有 10905 名患者测量了 RVSP。排除所有异常超声心动图，留下 1559 份超声心动图进行分析。
患者年龄在 15 至 93 岁之间。平均年龄为 49 岁。RVSP 仅在 50 岁以后才显著增加。年龄小于 50 岁、50 至 75 岁和大于 75 岁的患者的平均（+/-SD）RVSP 分别为 27.3+/-5.7mmHg、30.2+/-7.6mmHg 和 34.8+/-8.7mmHg（所有年龄组之间 P<0.0001）。年龄小于 50 岁、50 至 75 岁和大于 75 岁的患者的 RVSP 正常范围（95%CI）分别为 16mmHg 至 39mmHg、15mmHg 至 45mmHg 和 17mmHg 至 52mmHg。多变量分析表明，年龄、二尖瓣舒张早期到晚期充盈速度比、射血分数、主动脉大小和早期二尖瓣充盈速度/早期舒张期二尖瓣环速度是唯一重要的独立变量。随着年龄的增长，舒张功能发生显著变化，这可能是 RVSP 变化的原因。
男性和女性的 RVSP 在 50 岁之前保持稳定。此后，RVSP 随年龄呈线性递增，年龄大于 75 岁的患者明显更高。这些变化可能与舒张功能的变化有关。在无心血管疾病的情况下，使用超声心动图衍生的 RVSP 诊断肺动脉高压时，应考虑这些范围。
