Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
Am J Cardiol. 2013 Sep 15;112(6):873-82. doi: 10.1016/j.amjcard.2013.05.016. Epub 2013 Jun 1.
Pulmonary hypertension includes heterogeneous diagnoses with distinct hemodynamic pathophysiologic features. Identifying elevated pulmonary vascular resistance (PVR) is critical for appropriate treatment. We reviewed data from patients seen at referral pulmonary hypertension clinics who had undergone echocardiography and right-side cardiac catheterization within 1 year. We derived equations to estimate PVR using the ratio of estimated pulmonary artery (PA) systolic pressure (PASPDoppler) to right ventricular outflow tract velocity time integral (VTI). We validated these equations in a separate sample and compared them with a published model based on the ratio of the transtricuspid flow velocity to right ventricular outflow tract VTI (model 1, Abbas et al 2003). The derived models were as follows: PVR = 1.2 × (PASP/right ventricular outflow tract VTI) (model 2) and PVR = (PASP/right ventricular outflow tract VTI) + 3 if notch present (model 3). The cohort included 217 patients with mean PA pressure of 45.3 ± 11.9 mm Hg, PVR of 7.3 ± 5.0 WU, and PA wedge pressure of 14.8 ± 8.1 mm Hg. Just >1/3 had a PA wedge pressure >15 mm Hg (35.5%) and 82.0% had PVR >3 WU. Model 1 systematically underestimated catheterization estimated PVR, especially for those with high PVR. The derived models demonstrated no systematic bias. Model 3 correlated best with PVR (r = 0.80 vs r = 0.73 and r = 0.77 for models 1 and 2, respectively). Model 3 had superior discriminatory power for PVR >3 WU (area under the curve 0.946) and PVR >5 WU (area under the curve 0.924), although all models discriminated well. Model 3-estimated PVR >3 was 98.3% sensitive and 61.1% specific for PVR >3 WU (positive predictive value 93%; negative predictive value 88%). In conclusion, we present an equation to estimate the PVR, using the ratio of PASPDoppler to right ventricular outflow tract VTI and a constant designating presence of right ventricular outflow tract VTI midsystolic notching, which provides superior agreement with catheterization estimates of PVR across a wide range of values.
肺动脉高压包括具有不同血流动力学病理生理学特征的异质诊断。确定升高的肺血管阻力（PVR）对于适当的治疗至关重要。我们回顾了在 1 年内接受超声心动图和右侧心导管检查的转诊肺动脉高压诊所就诊的患者的数据。我们使用估计的肺动脉（PA）收缩压（PASPDoppler）与右心室流出道速度时间积分（VTI）的比值来推导估计 PVR 的方程。我们在单独的样本中验证了这些方程，并将其与基于三尖瓣血流速度与右心室流出道 VTI 比值的公布模型进行了比较（模型 1，Abbas 等人，2003 年）。推导的模型如下：PVR=1.2×（PASP/右心室流出道 VTI）（模型 2），如果存在切迹则为 PVR=（PASP/右心室流出道 VTI）+3（模型 3）。该队列包括 217 名患者，平均肺动脉压为 45.3±11.9mmHg，PVR 为 7.3±5.0WU，肺动脉楔压为 14.8±8.1mmHg。超过 1/3 的患者肺动脉楔压>15mmHg（35.5%），82.0%的患者 PVR>3WU。模型 1 系统地低估了导管估计的 PVR，尤其是对于那些 PVR 较高的患者。推导的模型没有系统偏差。模型 3 与 PVR 的相关性最好（r=0.80 与 r=0.73 和 r=0.77 分别为模型 1 和 2）。模型 3 在区分 PVR>3WU（曲线下面积 0.946）和 PVR>5WU（曲线下面积 0.924）方面具有更好的区分能力，尽管所有模型的区分能力都很好。模型 3 估计的 PVR>3 对于 PVR>3WU 的敏感性为 98.3%，特异性为 61.1%（阳性预测值为 93%；阴性预测值为 88%）。总之，我们提出了一种使用 PASPDoppler 与右心室流出道 VTI 的比值和一个常数来估计 PVR 的方程，该常数指定右心室流出道 VTI 收缩中期切迹的存在，这在广泛的 PVR 值范围内与导管估计值具有更好的一致性。
