Brierre Gilles, Blot-Souletie Nathalie, Degano Bruno, Têtu Laurent, Bongard Vanina, Carrié Didier
Federation of Cardiology, Toulouse-Rangueil University Hospital, Toulouse, France.
Eur J Echocardiogr. 2010 Jul;11(6):516-22. doi: 10.1093/ejechocard/jeq011. Epub 2010 Feb 25.
The present role of echocardiography is generally restricted to screening for pulmonary arterial hypertension (PAH). The aim of our study was to identify new echocardiographic prognostic factors for mortality in PAH which would give this imaging modality a genuine role in patient management.
At inclusion, all patients underwent right cardiac catheterization and echocardiography. Seventy-nine patients were followed for a median of 12 months, of whom 16 died of their pulmonary disease. We identified seven echocardiographic parameters that were associated with mortality, four of which have not previously been described in the literature: mean pulmonary artery pressure (PAP) >or=49 mmHg (P = 0.012), dPAP >or= 29 mmHg (P = 0.006), abnormal end-diastolic septal curve (P = 0.027), and inferior vena cava diameter >or=20 mm with respiratory variation of diameter <50% (P = 0.018). These parameters remained significant after adjustment for NYHA class and 6 min walk test distance.
Echocardiography should take an important place in the management of PAH and should not be restricted merely to screening for the disease.
目前超声心动图的作用通常局限于筛查肺动脉高压（PAH）。我们研究的目的是确定PAH患者死亡的新的超声心动图预后因素，从而使这种成像方式在患者管理中发挥真正作用。
纳入研究时，所有患者均接受了右心导管检查和超声心动图检查。79例患者接受了为期12个月的中位随访，其中16例死于肺部疾病。我们确定了7个与死亡率相关的超声心动图参数，其中4个参数此前在文献中未被描述：平均肺动脉压（PAP）≥49 mmHg（P = 0.012）、舒张期肺动脉压（dPAP）≥29 mmHg（P = 0.006）、舒张末期室间隔曲线异常（P = 0.027）以及下腔静脉直径≥20 mm且直径呼吸变化<50%（P = 0.018）。在校正纽约心脏协会（NYHA）心功能分级和6分钟步行试验距离后，这些参数仍然具有显著意义。
超声心动图在PAH的管理中应占据重要地位，不应仅仅局限于疾病筛查。
