Center for Diagnosis and Management of Pulmonary Vascular Diseases, Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China.
Chin Med J (Engl). 2011 Jun;124(11):1672-7.
An echocardiographic right/left ventricular end-diastolic diameter ratio (RV/LV ratio) ≥ 0.9 is an independent predictor of poor prognosis in patients with acute pulmonary embolism. Right ventricular dilation is a common characteristic of both acute pulmonary embolism and idiopathic pulmonary arterial hypertension (IPAH). However, the prognostic value of the RV/LV ratio in patients with IPAH is unknown.
Ninety-five consecutive patients with newly diagnosed IPAH were included, 17 were re-evaluated by echocardiography after 3 - 12 months of targeted therapy. Follow-up data were obtained by telephone interviews and review of the patients' records.
Higher RV/LV ratios were associated with greater functional impairment. The RV/LV ratio was positively correlated with pulmonary vascular resistance (r = 0.549, P < 0.001) and plasma N-terminal pro-brain natriuretic peptide level (r = 0.575, P < 0.001), but negatively correlated with cardiac output (r = -0.517, P < 0.001) and mixed venous oxygen saturation (r = -0.599, P < 0.001). Twenty-seven patients died during follow-up period. Sensitivity and specificity of an RV/LV ratio ≥ 0.84 for predicting death were 85.2% and 51.5%, respectively. The RV/LV ratio and body mass index were independent predictors of death by multivariate Cox analysis (P < 0.01). A baseline RV/LV ratio ≥ 0.84 or a further increase in the RV/LV ratio during targeted therapy indicated a poor prognosis (P < 0.01).
The RV/LV ratio helps to assess the severity of IPAH and may serve as an independent predictor of prognosis in patients with IPAH.
超声心动图右/左心室舒张末期直径比（RV/LV 比）≥0.9 是急性肺栓塞患者预后不良的独立预测因子。右心室扩张是急性肺栓塞和特发性肺动脉高压（IPAH）的共同特征。然而，RV/LV 比在 IPAH 患者中的预后价值尚不清楚。
纳入 95 例新诊断的 IPAH 连续患者，17 例在靶向治疗后 3-12 个月接受超声心动图复查。通过电话访谈和患者记录回顾获得随访数据。
RV/LV 比值越高，功能障碍越严重。RV/LV 比值与肺血管阻力呈正相关（r = 0.549，P <0.001），与血浆 N 端脑利钠肽前体水平呈正相关（r = 0.575，P <0.001），与心输出量呈负相关（r = -0.517，P <0.001），与混合静脉血氧饱和度呈负相关（r = -0.599，P <0.001）。27 例患者在随访期间死亡。RV/LV 比值≥0.84 预测死亡的敏感性和特异性分别为 85.2%和 51.5%。多因素 Cox 分析显示，RV/LV 比值和体重指数是死亡的独立预测因子（P <0.01）。基线 RV/LV 比值≥0.84 或靶向治疗期间 RV/LV 比值进一步增加提示预后不良（P <0.01）。
RV/LV 比值有助于评估 IPAH 的严重程度，可作为 IPAH 患者预后的独立预测因子。
