Sadauskas Saulius, Naudžiūnas Albinas, Unikauskas Alvydas, Gargasas Liudas, Ruseckas Rimtautas, Jurkonienė Rūta
Department of Internal Diseases, Medical Academy, Lithuanian University of Health Sciences, Josvainių 2, 47144 Kaunas, Lithuania.
Medicina (Kaunas). 2010;46(10):669-78.
THE OBJECTIVE OF THIS STUDY was to investigate the associations among clinical, impedance cardiography, echocardiography, and chest roentgenography data in diagnosis of pulmonary hypertension for patients with cardiovascular and pulmonary diseases.
Pulmonary artery pressure was measured by impedance cardiography method in 181 patients: 80 patients with cardiovascular pathology when pulmonary hypertension was determined by echocardiography, 69 patients with cardiovascular pathology when pulmonary hypertension was not observed using echocardiography, 19 patients with pulmonary pathology when pulmonary hypertension was determined by echocardiography, and 13 patients with pulmonary pathology when pulmonary hypertension was not observed using echocardiography. Clinical data, parameters of impedance cardiography, echocardiography, and chest roentgenography were evaluated.
Pulmonary hypertension (impedance cardiography) was diagnosed by computed mean blood pressure in pulmonary artery with a sensitivity and specificity of 72% and 90%, respectively, and by systolic blood pressure with a sensitivity and specificity of 96% and 90%, respectively. A mathematical model of binary regression was developed with a 96.7% accuracy to diagnose pulmonary hypertension. The most important parameters of impedance cardiography were systolic blood pressure in pulmonary artery and systolic time index.
Mean and systolic blood pressures in the pulmonary artery, assessed by a computerized impedance cardiogram, are diagnostically valuable parameters. In diagnostic algorithms of pulmonary hypertension, the following features can be used: atrial fibrillation; thrombosis of deep veins; dyspnea; cyanosis; accent of II tone at the auscultation point of the pulmonary valve; systolic murmur at the tricuspid valve area; increased diameter of the pulmonary artery more than ≥ 18 mm on chest x-ray; increased diameter of the right ventricle; systolic blood pressure in the pulmonary artery and systolic time index measured by impedance cardiography method.
本研究的目的是调查心血管和肺部疾病患者在肺动脉高压诊断中临床、阻抗心动图、超声心动图和胸部X线检查数据之间的关联。
采用阻抗心动图法测量了181例患者的肺动脉压:80例心血管疾病患者,其中超声心动图确诊为肺动脉高压;69例心血管疾病患者,超声心动图未发现肺动脉高压;19例肺部疾病患者,超声心动图确诊为肺动脉高压;13例肺部疾病患者,超声心动图未发现肺动脉高压。评估了临床数据、阻抗心动图、超声心动图和胸部X线检查的参数。
通过计算肺动脉平均血压诊断肺动脉高压(阻抗心动图),敏感性和特异性分别为72%和90%,通过收缩压诊断,敏感性和特异性分别为96%和90%。建立了二元回归数学模型,诊断肺动脉高压的准确率为96.7%。阻抗心动图最重要的参数是肺动脉收缩压和收缩时间指数。
通过计算机化阻抗心动图评估的肺动脉平均压和收缩压是有诊断价值的参数。在肺动脉高压的诊断算法中,可以使用以下特征:房颤;深静脉血栓形成;呼吸困难;发绀;肺动脉瓣听诊点第二心音亢进;三尖瓣区收缩期杂音;胸部X线显示肺动脉直径增加≥18mm;右心室直径增加;通过阻抗心动图法测量的肺动脉收缩压和收缩时间指数。