Tabib Avisa, Khorgami Mohammad Rafie, Meraji Mahmoud, Omidi Negar, Mirmesdagh Yalda
Heart Valve Disease Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
Pediatr Cardiol. 2014 Mar;35(3):521-9. doi: 10.1007/s00246-013-0818-x. Epub 2013 Oct 23.
This study aimed to evaluate the accuracy of Doppler echocardiography-derived indices in children with pulmonary hypertension secondary to congenital heart disease with left-to-right shunting. Doppler-derived indices including the acceleration time corrected (AcTc), deceleration time corrected, deceleration index, peak velocity, heart-rate-corrected inflection time (InTc), and a new index (the acceleration slope [Acc = peak flow velocity/AcTc]) were measured from the pulmonary artery (PA) systolic flow curve before and after 100 % oxygen administration in the main, left, and right PAs of 33 children. The acquired data were compared between low and high pulmonary vascular resistance (PVR) groups and between responders and nonresponders to the vasoreactivity test. The AcTc values differed significantly between the low and high PVR groups before and after oxygen administration in the main (P = 0.032 and <0.001, respectively), right (P = 0.011 and <0.001, respectively), and left (P < 0.001 and <0.001, respectively) PAs. The AcTc cutoff point in the main PA was 3.44 before oxygen administration (81% sensitivity and 91% specificity). The InTc in the main PA and its changes differed significantly between the low and high PVR groups before and after oxygen administration and between the responders and nonresponders (P = 0.016, 0.046, and 0.021, respectively). The velocity changes of the PA in the main PA differed significantly between the responders and nonresponders to oxygen administration (P < 0.001). The Acc and its changes differed significantly between the low and high PVR groups after oxygen administration and between the responders and nonresponders to oxygen administration (P = 0.044 and 0.006, respectively). Doppler echocardiographic examination using PA systolic flow indices in addition to PA reactivity testing is a promising technique for assessing PVR in children with congenital heart disease.
本研究旨在评估多普勒超声心动图衍生指标在先天性心脏病伴左向右分流所致肺动脉高压患儿中的准确性。在33例患儿的主肺动脉、左肺动脉和右肺动脉中，于吸入100%氧气前后，从肺动脉（PA）收缩期血流曲线测量多普勒衍生指标，包括校正加速时间（AcTc）、校正减速时间、减速指数、峰值流速、心率校正拐点时间（InTc）以及一个新指标（加速斜率[Acc = 峰值流速/AcTc]）。将获取的数据在低、高肺血管阻力（PVR）组之间以及血管反应性试验的反应者和无反应者之间进行比较。在主肺动脉、右肺动脉和左肺动脉中，低、高PVR组在吸氧前后的AcTc值差异均有统计学意义（主肺动脉分别为P = 0.032和<0.001，右肺动脉分别为P = 0.011和<0.001，左肺动脉分别为P < 0.001和<0.001）。吸氧前主肺动脉的AcTc截断点为3.44（敏感性81%，特异性91%）。主肺动脉的InTc及其变化在低、高PVR组吸氧前后以及反应者和无反应者之间差异均有统计学意义（分别为P = 0.016、0.046和P = 0.021）。吸氧反应者和无反应者之间主肺动脉的PA速度变化差异有统计学意义（P < 0.001）。吸氧后低、高PVR组之间以及吸氧反应者和无反应者之间的Acc及其变化差异均有统计学意义（分别为P = 0.044和P = 0.006）。除PA反应性测试外，使用PA收缩期血流指标的多普勒超声心动图检查是评估先天性心脏病患儿PVR的一种有前景的技术。
