Do Doan Hoa, Therrien Judith, Marelli Ariane, Martucci Giuseppe, Afilalo Jonathan, Sebag Igal A
Echocardiography Laboratory, Division of Cardiology, Sir Mortimer B. Davis-Jewish General Hospital, Montreal, Canada.
Echocardiography. 2011 Jan;28(1):109-16. doi: 10.1111/j.1540-8175.2010.01277.x. Epub 2010 Dec 22.
Noninvasive markers of right ventricular (RV) diastolic dysfunction are limited by their lack of reproducibility and accuracy. We tested the hypothesis that right atrial (RA) size measured by echocardiography was correlated to invasive parameters of RV diastolic filling.
We studied 31 consecutive adult patients with congenital heart disease. From 2D echocardiography images, we measured maximal RA long-axis and short-axis lengths, area and volume. We compared each of these measures to right ventricular end-diastolic pressure (RVEDP) and mean right atrial pressure (mRAP) measured by right heart catheterization. RA long-axis, short-axis, area, and volume correlated significantly with RVEDP (r = 0.78, P < 0.001; r = 0.61, P < 0.001; r = 0.79, P < 0.001; and r = 0.75, P < 0.001, respectively) and mRAP (r = 0.66, P < 0.001; r = 0.56, P = 0.002; r = 0.70, P < 0.001; r = 0.68, P < 0.001, respectively). Single cut points for each echocardiographic parameter demonstrated reasonable accuracy to rule-in and rule-out RVEDP ≥ 7 mm Hg (sensitivity = 74%, specificity = 82%, positive LR = 4.1, negative LR = 0.32 for RA long-axis of 49 mm; sensitivity = 89%, specificity = 82%, positive LR = 4.9, negative LR = 0.12 for RA area of 14 cm²; sensitivity = 89%, specificity = 82%, positive LR = 4.9, negative LR = 0.13 for RA volume of 37 mL).
RA size measured by echocardiography is strongly correlated to invasive parameters of RV diastolic filling and predicts high RV end-diastolic pressure.
右心室舒张功能障碍的无创性标志物因缺乏可重复性和准确性而受到限制。我们检验了通过超声心动图测量的右心房大小与右心室舒张期充盈的有创参数相关这一假设。
我们连续研究了31例成年先天性心脏病患者。从二维超声心动图图像中，我们测量了右心房最大长轴和短轴长度、面积和容积。我们将这些测量值中的每一个与通过右心导管检查测量的右心室舒张末期压力（RVEDP）和平均右心房压力（mRAP）进行比较。右心房长轴、短轴、面积和容积与RVEDP显著相关（分别为r = 0.78，P < 0.001；r = 0.61，P < 0.001；r = 0.79，P < 0.001；r = 0.75，P < 0.001）以及与mRAP显著相关（分别为r = 0.66，P < 0.001；r = 0.56，P = 0.002；r = 0.70，P < 0.001；r = 0.68，P < 0.001）。每个超声心动图参数的单一切点在判断RVEDP≥7 mmHg的排除和纳入方面显示出合理的准确性（右心房长轴49 mm时，敏感性 = 74%，特异性 = 82%，阳性似然比 = 4.1，阴性似然比 = 0.32；右心房面积14 cm²时，敏感性 = 89%，特异性 = 82%，阳性似然比 = 4.9，阴性似然比 = 0.12；右心房容积37 mL时，敏感性 = 89%，特异性 = 82%，阳性似然比 = 4.9，阴性似然比 = 0.13）。
通过超声心动图测量的右心房大小与右心室舒张期充盈的有创参数密切相关，并可预测较高的右心室舒张末期压力。
