Lopez-Candales Angel, Eleswarapu Ananth, Shaver James, Edelman Kathy, Gulyasy Beth, Candales Maria Dolores
Cardiovascular Institute, University of Pittsburgh Medical Center, Scaife 560, 200 Lothrop Street, Pittsburgh, PA 15213-2582, USA.
Eur J Echocardiogr. 2010 Jul;11(6):509-15. doi: 10.1093/ejechocard/jeq009. Epub 2010 Mar 5.
Right ventricular outflow tract (RVOT) acceleration shortens with chronic pulmonary hypertension (cPH). However, the overall value of this spectral Doppler signal in the assessment of PH patients is not well understood.
Markers of RV systolic performance, time to onset, time to peak, and total duration of the RVOT systolic spectral Doppler signal were examined. Group I consisted of 28 patients without PH [50 +/- 15 years and mean pulmonary artery systolic pressure (PASP) of 30 +/- 8 mmHg] and Group II included 52 patients with cPH (56 +/- 14 years and mean PASP of 80 +/- 27 mmHg; P < 0.0001). As expected, Group II patient's markers showed worse RV performance. In addition, Group II had a longer time to onset, a shorter time to peak, and a shorter total duration of the RVOT systolic signal than Group I. Both time to onset (r = 0.66 vs. r = -0.53; P < 0.0001) and time to peak (r = 0.65 vs. r = 0.50; P < 0.0001) of the RVOT signal correlated better with PH than RV fractional area change. Conversely, RV fractional area change correlated better with total duration of RVOT ejection (r = 0.66 vs. r = 0.58; P < 0.0001) than with PASP.
Timing of onset and peak of the RVOT systolic spectral signal appears to be useful in characterizing the severity of the PASP, while the total duration of RVOT ejection is a better predictor of the systolic performance of the RV in PH patients. More studies are now required to determine the clinical utility of prospectively measuring RVOT in cPH.
慢性肺动脉高压（cPH）时右心室流出道（RVOT）加速时间缩短。然而，这种频谱多普勒信号在评估肺动脉高压患者中的整体价值尚未得到充分理解。
研究了RV收缩功能的指标、RVOT收缩期频谱多普勒信号的起始时间、峰值时间和总持续时间。第一组由28例无肺动脉高压的患者组成[年龄50±15岁，平均肺动脉收缩压（PASP）为30±8 mmHg]，第二组包括52例cPH患者（年龄56±14岁，平均PASP为80±27 mmHg；P<0.0001）。正如预期的那样，第二组患者的指标显示RV功能较差。此外，第二组的起始时间更长，峰值时间更短，RVOT收缩期信号的总持续时间比第一组更短。RVOT信号的起始时间（r = 0.66 vs. r = -0.53；P<0.0001）和峰值时间（r = 0.65 vs. r = 0.50；P<0.0001）与肺动脉高压的相关性比RV面积变化分数更好。相反，RV面积变化分数与RVOT射血总持续时间的相关性（r = 0.66 vs. r = 0.58；P<0.0001）比与PASP的相关性更好。
RVOT收缩期频谱信号的起始和峰值时间似乎有助于表征PASP的严重程度，而RVOT射血的总持续时间是肺动脉高压患者RV收缩功能更好的预测指标。现在需要更多的研究来确定前瞻性测量cPH患者RVOT的临床实用性。
