Constantinescu Tudor, Magda Stefania Lucia, Niculescu Rodica, Mincu Raluca Ileana, Zaharia Dragos, Toma Claudia Lucia, Cinteza Mircea, Bogdan Miron Alexandru
"Marius Nasta" Institute of Pneumology, Bucharest, Romania.
University Emergency Hospital, Bucharest, Romania.
Maedica (Bucur). 2013 Jun;8(2):116-23.
Pulmonary arterial hypertension (PAH) represents an emerging pathology in modern medicine. Transthoracic echocardiography is an inexpensive and reproducible method and it is the most commonly used non-invasive diagnostic tool to asses pulmonary artery pressure (PAP) and the function of the right ventricle. Although, the right heart catheterization is still considered as the standard for the diagnosis, according to the last guidelines, the new echocardiographic methods may offer an improved value in the PAH evaluation.
To evaluate if cardiac ultrasonography data correlate with catheterization results in patients with PAH (Group I Dana Point 2008), and to compare the ultrasonography evaluation of PAH patients with that of normal.
15 consecutive patients (pts) (52±15 yrs, 5 men, time from onset of symptoms 1.6±1.7 years) with PAH of different aetiologies (12 pts with idiopathic PAH, 2 pts with PAH associated with scleroderma and one with persistent PAH after atrial septal defect (ASD) closure) were evaluated through: 1. clinical examination (NYHA class); 2. exercise capacity (6 minute walking test - 6MWT); 3. conventional echocardiography (diameter of right ventricle - RVD and right atrium, fractional area shortening - FAS, TAPSE, pulmonary ascension time - PA, systolic and mean PAP -sPAP, mPAP, tricuspid E/A ratio, cardiac index-CI) and 4. Tissue Doppler Imaging - TDI (systolic and diastolic myocardial velocities at the tricuspid annulus - S, D, A); 5. right heart catheterization (sPAP, mPAP, CI, pulmonary vascular resistance - PVR)We compared classical and TDI echo parameters with those obtained from 15 normal subjects, matched in age and sex.
PAH patients had high sPAP and mPAP with right heart dilation (RV - 44.8±7.3 mm), depressed TAPSE (16.2±5.9 mm) and cardiac index and low TDI systolic velocities at tricuspid level (7.3±2.9 cm/s). All parameters differed statistically significant from normal. There were no significant correlations between ultrasonography and catheterization (cath) parameters (sPAP 92±28.2 echo vs. 106.4±25.8 mmHg cath; mPAP 47.9±8.4 echo vs. 65.8±17.3 mmHg cath), excepting for CI 2.3±1.2 l/min/m(2) vs. 2.08±0.3 ml/min/m(2)) and PVR (16.5 ± 15.3 Wood U echo, vs. 19.6 ± 7.9 cath).
Classic and TDI cardiac ultrasonography represents a good screening and monitoring tool for PAH patients, but tends to underestimate the severity of the disease, leaving right heart catheterization as the essential diagnostic method for this rare disease.
肺动脉高压（PAH）是现代医学中一种新出现的病症。经胸超声心动图是一种价格低廉且可重复的方法，是评估肺动脉压（PAP）和右心室功能最常用的非侵入性诊断工具。尽管右心导管检查仍被视为诊断的金标准，但根据最新指南，新的超声心动图方法在PAH评估中可能具有更高的价值。
评估心脏超声检查数据与PAH患者（I组，达纳点2008年分类）的导管检查结果是否相关，并比较PAH患者与正常人的超声心动图评估结果。
连续纳入15例不同病因的PAH患者（年龄52±15岁，男性5例，症状出现时间1.6±1.7年）（12例特发性PAH患者，2例硬皮病相关PAH患者，1例房间隔缺损（ASD）封堵术后持续性PAH患者），通过以下方式进行评估：1. 临床检查（纽约心脏协会分级）；2. 运动能力（6分钟步行试验 - 6MWT）；3. 常规超声心动图（右心室直径 - RVD、右心房、面积缩短分数 - FAS、三尖瓣环平面收缩期位移 - TAPSE、肺动脉上升时间 - PA、收缩期和平均PAP - sPAP、mPAP、三尖瓣E/A比值、心脏指数 - CI）以及4. 组织多普勒成像 - TDI（三尖瓣环处的收缩期和舒张期心肌速度 - S、D、A）；5. 右心导管检查（sPAP、mPAP、CI、肺血管阻力 - PVR）。我们将经典和TDI超声心动图参数与15例年龄和性别匹配的正常受试者获得的参数进行比较。
PAH患者sPAP和mPAP升高，伴有右心扩大（RV - 44.8±7.3 mm），TAPSE降低（16.2±5.9 mm），心脏指数降低，三尖瓣水平TDI收缩期速度较低（7.3±2.9 cm/s）。所有参数与正常组相比差异均有统计学意义。超声心动图与导管检查（cath）参数之间无显著相关性（sPAP超声心动图为92±28.2 vs. 导管检查为106.4±25.8 mmHg；mPAP超声心动图为47.9±8.4 vs. 导管检查为65.8±17.3 mmHg），但CI（2.3±1.2 l/min/m² vs. 2.08±0.3 ml/min/m²）和PVR（16.5 ± 15.3 Wood U超声心动图，vs. 19.6 ± 7.9导管检查）除外。
经典和TDI心脏超声检查是PAH患者良好的筛查和监测工具，但往往会低估疾病的严重程度，右心导管检查仍是这种罕见疾病的必要诊断方法。
