Division of Cardiology, University of Utah, Salt Lake City, Utah, USA.
Am J Cardiol. 2010 Dec 1;106(11):1657-62. doi: 10.1016/j.amjcard.2010.07.022. Epub 2010 Oct 14.
Candidacy for heart transplantation is influenced by the severity of pulmonary hypertension. In this study, invasive hemodynamics from right-sided cardiac catheterization were compared with values obtained by validated equations from Doppler 2-dimensional transthoracic echocardiography. This prospective study was conducted in 40 patients with end-stage heart failure evaluated for heart transplantation or ventricular assist device implantation. Transthoracic echocardiography and right-sided cardiac catheterization were performed within 4 hours. From continuous-wave Doppler of the tricuspid regurgitation jet, pulmonary artery systolic pressure was calculated as the peak gradient across the tricuspid valve plus right atrial pressure estimated from inferior vena cava filling. Mean pulmonary artery pressure was calculated as (0.61 × pulmonary artery systolic pressure) + 2. Pulmonary vascular resistance (PVR) was calculated as (tricuspid regurgitation velocity/right ventricular outflow tract time-velocity integral × 10) + 0.16. Pulmonary capillary wedge pressure was calculated as 1.91 + (1.24 × E/E'). Pearson's correlation and Bland-Altman analysis of mean differences between echocardiographic and right-sided cardiac catheterization measurements were statistically significant for all hemodynamic parameters (pulmonary artery systolic pressure: r = 0.82, p < 0.05, mean difference 3.1 mm Hg, 95% confidence interval [CI] -0.2 to 6.3; mean pulmonary artery pressure: r = 0.80, p < 0.05, mean difference 2.5 mm Hg, 95% CI 0.3 to 4.6; PVR: r = 0.52, p < 0.05, mean difference 0.8 Wood units, 95% CI 0.3 to 1.4; pulmonary capillary wedge pressure: r = 0.65, p < 0.05, mean difference 2.2 mm Hg, 95% CI 0.1 to 4.3). Compared with right-sided cardiac catheterization, PVR by Doppler echocardiography identified all patients with PVR > 4 Wood units (n = 4), 73% of patients with PVR <2 Wood units (n = 8), and 52% of patients with PVR from 2 to 4 Wood units (n = 10). In conclusion, echocardiographic estimation of cardiopulmonary hemodynamics is reliable in patients with end-stage cardiomyopathy. The noninvasive assessment of hemodynamics by echocardiography may be able to decrease the number of serial right-sided cardiac catheterizations in selected patients awaiting heart transplantation. However, in patients with borderline PVR, right-sided cardiac catheterization is indicated to assess eligibility for transplantation.
心脏移植候选人的选择受到肺动脉高压严重程度的影响。在这项研究中，将右心导管插入术的侵入性血流动力学与通过多普勒二维经胸超声心动图获得的验证方程的值进行了比较。这项前瞻性研究共纳入 40 例终末期心力衰竭患者，这些患者正在接受心脏移植或心室辅助装置植入评估。经胸超声心动图和右心导管术在 4 小时内完成。通过三尖瓣反流射流的连续波多普勒，肺动脉收缩压计算为三尖瓣跨瓣峰压差加上下腔静脉充盈时估计的右心房压。平均肺动脉压计算为（0.61×肺动脉收缩压）+2。肺动脉阻力（PVR）计算为（三尖瓣反流速度/右心室流出道时间-速度积分×10）+0.16。肺毛细血管楔压计算为 1.91+（1.24×E/E'）。超声心动图和右心导管术测量的所有血流动力学参数的 Pearson 相关和均数差值的 Bland-Altman 分析均具有统计学意义（肺动脉收缩压：r=0.82，p<0.05，平均差值 3.1mmHg，95%置信区间[CI] -0.2 至 6.3；平均肺动脉压：r=0.80，p<0.05，平均差值 2.5mmHg，95%CI 0.3 至 4.6；PVR：r=0.52，p<0.05，平均差值 0.8 伍德单位，95%CI 0.3 至 1.4；肺毛细血管楔压：r=0.65，p<0.05，平均差值 2.2mmHg，95%CI 0.1 至 4.3）。与右心导管术相比，超声心动图估测的 PVR 可识别所有 PVR>4 伍德单位的患者（n=4）、73%的 PVR<2 伍德单位的患者（n=8）和 52%的 PVR 为 2 至 4 伍德单位的患者（n=10）。结论：在终末期扩张型心肌病患者中，超声心动图估测心肺血流动力学是可靠的。超声心动图对血流动力学的非侵入性评估可能能够减少等待心脏移植的选定患者的连续右心导管术数量。然而，对于 PVR 临界值的患者，需要进行右心导管术以评估是否适合移植。
