D'Alto Michele, Romeo Emanuele, Argiento Paola, D'Andrea Antonello, Vanderpool Rebecca, Correra Anna, Bossone Eduardo, Sarubbi Berardo, Calabrò Raffaele, Russo Maria Giovanna, Naeije Robert
Cardiology, Second University of Naples, Monaldi Hospital, Naples, Italy.
Int J Cardiol. 2013 Oct 9;168(4):4058-62. doi: 10.1016/j.ijcard.2013.07.005. Epub 2013 Jul 23.
Echocardiographic studies have contributed to progress in the understanding of the pathophysiology of the pulmonary circulation and have been shown to be useful for screening for and prognostication of pulmonary hypertension, but are considered unreliable for the diagnosis of pulmonary hypertension. We explored this apparent paradox with rigorous Bland and Altman analysis of the accuracy and the precision of measurements collected in a large patient population.
A total of 161 patients referred for a suspicion of pulmonary hypertension were prospectively evaluated by a Doppler echocardiography performed by dedicated cardiologists within 1 h of an indicated right heart catheterization.
Nine of the patients (6%) were excluded due to an insufficient signal quality. Of the remaining 152 patients, 10 (7%) had no pulmonary hypertension and most others had either pulmonary arterial hypertension (36%) or pulmonary venous hypertension (40%) of variable severities. Mean pulmonary artery pressure, left atrial pressure and cardiac output were nearly identical at echocardiography and catheterization, with no bias and tight confidence intervals, respectively ± 3 mm Hg, ± 5 mm Hg and ± 0.3 L/min. However, the ± 2SD limits of agreement were respectively of + 19 and - 18 mm Hg for mean pulmonary artery pressure, + 8 and - 12 mm Hg for left atrial pressure and + 1.8 and - 1.7 L/min for cardiac output.
Doppler echocardiography allows for accurate measurements of the pulmonary circulation, but with moderate precision, which explains why the procedure is valid for population studies but cannot be used for the individual diagnosis of pulmonary hypertension.
超声心动图研究有助于加深对肺循环病理生理学的理解，已被证明对肺动脉高压的筛查和预后评估有用，但被认为对肺动脉高压的诊断不可靠。我们通过对大量患者群体收集的测量数据的准确性和精密度进行严格的布兰德-奥特曼分析，探讨了这一明显的矛盾。
共有161例疑似肺动脉高压的患者，由专业心脏病专家在右心导管检查指示后1小时内进行多普勒超声心动图前瞻性评估。
9例患者（6%）因信号质量不足被排除。在其余152例患者中，10例（7%）无肺动脉高压，大多数其他患者患有不同严重程度的肺动脉高压（36%）或肺静脉高压（40%）。超声心动图和导管检查时的平均肺动脉压、左心房压和心输出量几乎相同，分别无偏差且置信区间紧密，分别为±3 mmHg、±5 mmHg和±0.3 L/min。然而，平均肺动脉压的一致性±2SD界限分别为+19和-18 mmHg，左心房压为+8和-12 mmHg，心输出量为+1.8和-1.7 L/min。
多普勒超声心动图能够准确测量肺循环，但精密度适中，这解释了为什么该检查对群体研究有效，但不能用于个体肺动脉高压的诊断。
