University of Liège, Department of Cardiology, University Hospital Sart Tilman, Liège, Belgium.
J Am Soc Echocardiogr. 2011 Sep;24(9):1004-12. doi: 10.1016/j.echo.2011.04.003. Epub 2011 May 17.
Exercise systolic pulmonary arterial pressure (SPAP) predicts the occurrence of symptoms in patients with degenerative mitral regurgitation (MR). However, this measurement is not always available. The purpose of this study was to identify resting echocardiographic predictors of exercise SPAP and whether predicted exercise SPAP may predict symptom-free survival.
We prospectively enrolled 89 consecutive asymptomatic patients with moderate or greater degenerative MR in whom exercise SPAP was measurable. Left ventricular (LV) systolic and diastolic function were assessed by comprehensive transthoracic echocardiography. Tissue Doppler imaging was used to measure Ea- (early diastolic) and Sa- (systolic) wave velocities and time-to-peak (TP) Sa velocity. Multiple linear regression was built to identify resting predictors of exercise SPAP.
Patients with exercise pulmonary hypertension (PHT) (n = 45, 51%) were significantly older and more frequently male, and had shorter TP-Sa velocity and higher E/Ea ratio and LV end-diastolic volume than those without exercise PHT. Exercise SPAP was best correlated with resting LV end-diastolic volume (r = 0.55), TP-Sa (r = 0.72), and E/Ea ratio (r = 0.52). Multiple linear regression analysis allowed us to build the following predictive equation with good precision (r(2) = 0.80): By using this formula, predicted exercise SPAP was well correlated with observed exercise SPAP (r = 0.89). Predicted exercise PHT was associated with significant reduced symptom-free survival in both univariate (P = .04) and multivariate (P = .045) analyses.
In asymptomatic patients with degenerative MR, exercise PHT can be accurately predicted using resting comprehensive echocardiography.
运动时肺动脉收缩压（SPAP）可预测退行性二尖瓣反流（MR）患者症状的发生。然而，这种测量并不总是可行的。本研究旨在确定静息超声心动图预测运动 SPAP 的指标，以及预测的运动 SPAP 是否可预测无症状生存。
我们前瞻性纳入了 89 例连续的、无症状的、中重度退行性 MR 患者，这些患者的运动 SPAP 是可测量的。通过综合经胸超声心动图评估左心室（LV）收缩和舒张功能。组织多普勒成像用于测量 Ea（早期舒张）和 Sa（收缩）波速度以及峰值时间 Sa 速度。建立多元线性回归模型以确定运动 SPAP 的静息预测指标。
运动性肺动脉高压（PHT）（n=45，51%）患者年龄较大且更常为男性，TP-Sa 时间更短，E/Ea 比值和 LV 舒张末期容积更高。运动 SPAP 与静息 LV 舒张末期容积（r=0.55）、TP-Sa（r=0.72）和 E/Ea 比值（r=0.52）相关性最好。多元线性回归分析允许我们建立一个具有良好精度的预测方程（r²=0.80）：使用该公式，预测的运动 SPAP 与观察到的运动 SPAP 相关性良好（r=0.89）。预测的运动性 PHT 在单变量（P=0.04）和多变量（P=0.045）分析中均与无症状生存时间显著缩短相关。
在无症状退行性 MR 患者中，静息综合超声心动图可准确预测运动性 PHT。
