Finkelhor Robert S, Scrocco John D, Madmani Mohammed, Rovner Aleksandr, Pillai Dilip
Case Western Reserve University at the MetroHealth Medical Center Campus, Cleveland, Ohio.
Echocardiography. 2014 Mar;31(3):279-84. doi: 10.1111/echo.12361. Epub 2013 Sep 13.
Although the echo Doppler (D) estimation of pulmonary artery systolic pressure (PASP) was initially highly correlated with right heart catheterization (RHC), recent D-RHC studies have questioned its accuracy. The aim of this study was to reevaluate this relationship and to determine possible explanations for disparate D-RHC results.
We retrospectively identified all patients at one institution who underwent RHC and had an echocardiogram within the prior month. Echocardiographic and catheterization hemodynamic factors were evaluated by regression and Bland-Altman analysis.
Of 69 patients, 52 (75.4%) had estimable D-PASP. D-RHC PASP r = 0.62 and 51.9% had a PASP difference >10 mmHg, comparable to other recent studies. The D-RHC difference correlated with pulmonary capillary wedge pressure (PCWP) (r = -0.60, P < 0.001) and right atrial pressure (r = -0.43, P = 0.002). Multivariate analysis including wedge pressure improved the relation between D and RHC for PASP (r = 0.86). These results were little changed using only the respective RV-RA pressure gradients from D and RHC.
Pulmonary capillary wedge pressure appears to be a significant covariate in the correlation between D and RHC PASP.
尽管最初肺动脉收缩压（PASP）的超声多普勒（D）估测值与右心导管检查（RHC）高度相关，但近期的D-RHC研究对其准确性提出了质疑。本研究的目的是重新评估这种关系，并确定D-RHC结果存在差异的可能原因。
我们回顾性确定了一家机构内所有在前一个月内接受了RHC并进行了超声心动图检查的患者。通过回归分析和Bland-Altman分析评估超声心动图和导管检查的血流动力学因素。
在69例患者中，52例（75.4%）可估测D-PASP。D-RHC的PASP r = 0.62，51.9%的患者PASP差值>10 mmHg，与其他近期研究结果相当。D-RHC差值与肺毛细血管楔压（PCWP）相关（r = -0.60，P < 0.001），与右心房压相关（r = -0.43，P = 0.002）。纳入楔压的多变量分析改善了D与RHC之间PASP的关系（r = 0.86）。仅使用D和RHC各自的右心室-右心房压力梯度时，这些结果变化不大。
肺毛细血管楔压似乎是D与RHC PASP相关性中的一个重要协变量。
