Third Department of Cardiology, University of Athens School of Medicine, Athens, Greece.
J Heart Lung Transplant. 2013 May;32(5):511-7. doi: 10.1016/j.healun.2013.01.986. Epub 2013 Feb 9.
Although the clinical assessment of jugular venous pressure (JVP) provides accurate estimate of right atrial pressure (RAP), there is no reliable non-invasive method for assessing pulmonary capillary wedge pressure (PCWP). Our objective was to evaluate the sensitivity and specificity for detecting elevated left ventricular filling pressures using a model for PCWP estimation, based on the clinical assessment of RAP and association between RAP and PCWP, which is unique for each patient, identified in a recent right heart catheterization (RHC).
The study included 377 patients (age, 54.3 ± 13 years) with heart failure with reduced ejection fraction (left ventricular ejection fraction of 30.5 ± 10.8%) who underwent 2 RHCs within 1 year. In Group A (189 randomly selected patients), hemodynamic variables with significant correlation with the current wedge pressure (PCWP(2)) were identified and an equation estimating PCWP(2) based on these variables was formed. The validity of the equation was evaluated in the remaining 188 patients (Group B). The equation was also evaluated, prospectively in 39 new patients where RAP was estimated clinically, by physicians blinded to the results of the RHC.
PCWP(2) in Group A correlated with RAP(1), systolic pulmonary artery pressure (SPAP(1)), and PCWP(1) of the first RHC and with RAP(2) and SPAP(2) of the second. The equation is PCWP(2) = [3RAP(2) + (PCWP(1) - RAP(1)) + 4]/2. In Group B, the sensitivity and specificity of estimated PCWP(2) for diagnosis of elevated LV filling pressures (invasive values >18 mm Hg) was significant, reflected by an area under the curve (AUC) of 0.954 (p < 0.001). In the prospective sub-group, where JVP was entered in the formula as an estimate of RAP(2), correlation between estimated and measured PCWP(2) was r = 0.803 (p < 0.001).
The current PCWP of a patient with heart failure can be estimated accurately by a simple equation based on measurements of a previous RHC and the current value of clinically assessed JVP.
虽然颈静脉压（JVP）的临床评估能准确估计右心房压（RAP），但目前还没有可靠的非侵入性方法来评估肺毛细血管楔压（PCWP）。我们的目的是评估一种基于 RAP 临床评估和 RAP 与 PCWP 之间关联的 PCWP 估计模型的敏感性和特异性，该模型是为每位患者确定的，这些关联在最近的右心导管检查（RHC）中是独一无二的。
这项研究纳入了 377 例射血分数降低的心力衰竭患者（年龄 54.3 ± 13 岁），这些患者在 1 年内接受了 2 次 RHC。在 A 组（189 例随机选择的患者）中，确定与当前楔压（PCWP（2））有显著相关性的血流动力学变量，并根据这些变量形成一个估计 PCWP（2）的方程。该方程在其余 188 例患者（B 组）中进行了验证。该方程还在 39 例新患者中进行了前瞻性评估，这些患者的 RAP 由临床医生进行评估，医生对 RHC 的结果不知情。
A 组中，PCWP（2）与 RAP（1）、收缩期肺动脉压（SPAP（1））和第一次 RHC 的 PCWP（1）相关，与第二次 RHC 的 RAP（2）和 SPAP（2）相关。该方程为 PCWP（2）=[3RAP（2）+（PCWP（1）-RAP（1））+4]/2。在 B 组中，估计的 PCWP（2）对诊断 LV 充盈压升高（侵入性值>18mmHg）的敏感性和特异性具有显著意义，曲线下面积（AUC）为 0.954（p<0.001）。在前瞻性亚组中，将 JVP 作为 RAP（2）的估计值输入公式，估计的和测量的 PCWP（2）之间的相关性为 r=0.803（p<0.001）。
基于对以前的 RHC 测量和当前临床评估的 JVP 值，可通过一个简单的方程准确估计心力衰竭患者的当前 PCWP。
