超声心动图参数在肺动脉高压患者中的变化：与心脏磁共振和血流动力学衍生的右心室射血分数的相关性。
Echocardiographic parameters in patients with pulmonary arterial hypertension: correlations with right ventricular ejection fraction derived from cardiac magnetic resonance and hemodynamics.
机构信息
State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
出版信息
PLoS One. 2013 Aug 14;8(8):e71276. doi: 10.1371/journal.pone.0071276. eCollection 2013.
BACKGROUND
Echocardiography is the most convenient method used to evaluate right ventricular function, and several echocardiographic parameters were studied in previous studies. But the value of these parameters to assess the right ventricular function in patients with pulmonary arterial hypertension (PAH) has not been well defined.
METHODS
Patients with PAH were observed prospectively. Right heart catheterization, echocardiography and cardiac magnetic resonance (CMR) were performed within 1 week interval. The correlations between echocardiographic parameters and right ventricular ejection fraction (RVEF) derived from CMR as well as hemodynamics were analyzed.
RESULTS
Thirty patients were enrolled including 24 with idiopathic PAH, 5 with PAH associated with connective tissue diseases and 1 with hereditary PAH. All echocardiographic parameters except right ventricular myocardial performance index (RVMPI) correlated significantly with RVEF (tricuspid annual plane systolic excursion [TAPSE], r = 0.440, P = 0.015; tricuspid annular systolic excursion velocity [S'], r = 0.444, P = 0.016; isovolumic acceleration [IVA], r = 0.600, P = 0.001; right ventricular fraction area change [RVFAC], r = 0.416, P = 0.022; ratio of right ventricular transverse diameter to left ventricular transverse diameter [RVETD/LVETD], r = -0.649, P<0.001; RVMPI, r = -0.027, P = 0.888). After adjusted for mean right atrial pressure, mean pulmonary arterial pressure and pulmonary vascular resistance (PVR), only IVA and RVETD/LVETD could independently predict RVEF. Four echocardiographic parameters displayed significant correlations with PVR (TAPSE, r = -0.615, P<0.001; S', r = -0.557, P = 0.002; RVFAC, r = -0.454, P = 0.012; RVETD/LVETD, r = 0.543, P = 0.002).
CONCLUSIONS
The echocardiographic parameters IVA and RVETD/LVETD can reflect RVEF independently regardless of hemodynamics in patients with PAH. In addition, TAPSE, S', RVFAC and RVETD/LVETD can also reflect PVR in PAH patients.
背景
超声心动图是评估右心室功能最方便的方法，既往研究中已经研究了几种超声心动图参数。但这些参数在肺动脉高压（PAH）患者中的评估右心室功能的价值尚未明确。
方法
前瞻性观察 PAH 患者。在 1 周内进行右心导管检查、超声心动图和心脏磁共振（CMR）检查。分析超声心动图参数与 CMR 得出的右心室射血分数（RVEF）以及血流动力学之间的相关性。
结果
共纳入 30 例患者，其中特发性 PAH 24 例，结缔组织病相关 PAH 5 例，遗传性 PAH 1 例。除右心室心肌做功指数（RVMPI）外，所有超声心动图参数均与 RVEF 显著相关（三尖瓣环平面收缩期位移[TAPSE]，r=0.440，P=0.015；三尖瓣环收缩期运动速度[S']，r=0.444，P=0.016；等容加速度[IVA]，r=0.600，P=0.001；右心室面积变化分数[RVFAC]，r=0.416，P=0.022；右心室横径与左心室横径比值[RVETD/LVETD]，r=-0.649，P<0.001；RVMPI，r=-0.027，P=0.888）。校正平均右心房压、平均肺动脉压和肺血管阻力（PVR）后，仅 IVA 和 RVETD/LVETD 可独立预测 RVEF。4 项超声心动图参数与 PVR 呈显著相关性（TAPSE，r=-0.615，P<0.001；S'，r=-0.557，P=0.002；RVFAC，r=-0.454，P=0.012；RVETD/LVETD，r=0.543，P=0.002）。
结论
在 PAH 患者中，无论血流动力学如何，超声心动图参数 IVA 和 RVETD/LVETD 均可独立反映 RVEF。此外，TAPSE、S'、RVFAC 和 RVETD/LVETD 也可以反映 PAH 患者的 PVR。
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