Angtuaco Michael J, Vyas Himesh V, Malik Sadia, Seib Paul M, Morrow W Robert, Sachdeva Ritu
Department of Pediatrics, Division of Pediatric Cardiology, University of Arkansas for Medical Sciences, Little Rock, Ark 72202, USA.
Congenit Heart Dis. 2012 Mar-Apr;7(2):131-8. doi: 10.1111/j.1747-0803.2011.00578.x. Epub 2011 Oct 20.
Diastolic pulmonary artery pressure (dPAP) is equal to right ventricular pressure at the time of pulmonary valve opening. We studied the accuracy of dPAP estimated from Doppler profile of tricuspid regurgitation (TR) jet in pediatric patients.
Echocardiograms were prospectively performed on consecutive pediatric heart transplant recipients undergoing right-heart catheterization and endomyocardial biopsy. An estimate of dPAP was obtained by superimposing the pulmonary valve opening time, indexed to the electrocardiogram, onto the TR Doppler tracing. Echocardiographic estimates of dPAP from end-diastolic pulmonary regurgitation (PR) were obtained for comparison. Catheter-derived right atrial pressure was added to the Doppler gradient in both groups. Doppler estimates and catheter-derived measurements of dPAP were compared using Lin correlation and Bland-Altman analysis.
Sixty-five catheterization studies were performed on 35 patients (20 males): median age at enrollment: 12.1 years (4 months to 18 years); median time: since transplant of 1.2 years (21 days to 16.1 years). Adequate TR signal was obtained in a significantly higher proportion of patients than an adequate PR signal (65% vs. 43%, respectively, P = .007). Median catheter-derived dPAP was 12 mm Hg (6-30 mm Hg) and right atrial pressure was 6 mm Hg (1-17 mm Hg). Median estimated dPAP from TR was 15 mm Hg (range: 7-29 mm Hg), with the Lin correlation coefficient of 0.74 (95% confidence interval [CI]: 0.6-0.87). Median estimate for dPAP from PR was 10 mm Hg (range: 2-25 mm Hg), with the Lin correlation coefficient of 0.74 (95% CI: 0.58-0.9). There was excellent interobserver agreement for dPAP from TR with the Lin correlation coefficient of 0.946 (95% CI: 0.803-0.986).
Doppler estimation of dPAP from TR is a novel, reliable, noninvasive method and compares favorably with estimation from PR. Adequate TR signal for estimation of dPAP can be obtained more frequently in children than adequate PR signal, thereby increasing the proportion of patients in whom dPAP can be estimated noninvasively.
舒张期肺动脉压（dPAP）等于肺动脉瓣开放时的右心室压力。我们研究了根据小儿患者三尖瓣反流（TR）射流的多普勒频谱估算dPAP的准确性。
对连续接受右心导管检查和心内膜心肌活检的小儿心脏移植受者进行前瞻性超声心动图检查。通过将以心电图为指标的肺动脉瓣开放时间叠加到TR多普勒描记图上来获得dPAP的估算值。同时获取舒张期末期肺动脉反流（PR）的dPAP超声心动图估算值以作比较。两组均将导管测得的右心房压力加到多普勒梯度上。使用线性相关分析和布兰德-奥特曼分析比较dPAP的多普勒估算值和导管测量值。
对35例患者（20例男性）进行了65次导管检查研究：入组时的中位年龄为12.1岁（4个月至18岁）；自移植后的中位时间为1.2年（21天至16.1年）。获得足够TR信号的患者比例显著高于获得足够PR信号的患者比例（分别为65%和43%，P = 0.007）。导管测得的dPAP中位数为12 mmHg（6 - 30 mmHg），右心房压力为6 mmHg（1 - 17 mmHg）。TR估算的dPAP中位数为15 mmHg（范围：7 - 29 mmHg），线性相关系数为0.74（95%置信区间[CI]：0.6 - 0.87）。PR估算的dPAP中位数为10 mmHg（范围：2 - 25 mmHg），线性相关系数为0.74（95% CI：0.58 - 0.9）。TR估算的dPAP观察者间一致性极佳，线性相关系数为0.946（95% CI：0.803 - 0.986）。
根据TR估算dPAP是一种新颖、可靠的非侵入性方法，与根据PR估算相比具有优势。在儿童中，获得足够用于估算dPAP的TR信号比获得足够的PR信号更频繁，从而增加了可以非侵入性估算dPAP的患者比例。
