Rice Jessica L, Stream Amanda R, Fox Daniel L, Geraci Mark W, Vandivier R William, Dorosz Jennifer L, Bull Todd M
a Division of Pulmonary Sciences and Critical Care Medicine , University of Colorado , Aurora , Colorado , USA.
b Colorado Pulmonary Vascular Disease Center , University of Colorado , Aurora , Colorado , USA.
COPD. 2016 Oct;13(5):595-600. doi: 10.3109/15412555.2015.1134468. Epub 2016 Feb 1.
Pulmonary hypertension (PH) is a common complication of chronic obstructive pulmonary disease (COPD), increasing morbidity and mortality. Current echocardiographic measures have poor predictive value for the diagnosis of PH in COPD. Right ventricular (RV) strain obtained by speckle tracking echocardiography (STE) is a measure of myocardial deformation which correlates with RV function and survival in subjects with pulmonary arterial hypertension. We hypothesized that RV strain measurements would be feasible and correlate with invasive hemodynamic measurements in patients with COPD. Retrospective analysis of RV strain values from subjects with severe COPD with echocardiogram within 48 hours of right heart catheterization was performed. First, 54 subjects were included in the analysis. Right ventricular systolic pressure (RVSP) and RV strain could be estimated in 31% and 57%, respectively. Then, 61% had RV-focused apical views, and of those, RV strain could be obtained for 94%. RV free wall strain correlated with PVR (r = 0.41, p = 0.02). Subjects with pulmonary vascular resistance (PVR) > 3 Wood units (WU) had less negative (worse) RV free wall strain values than those with PVR ≤ 3 WU, with a median strain of -20 (-23, -12) versus -23 (-29, -15), p < 0.05. A receiver operating characteristic curve demonstrated an RV free wall strain of > -23 to be 92% sensitive and 44% specific for identifying PVR > 3 WU (AUC 0.71). RV strain estimates are feasible in the majority of subjects with severe COPD. RV strain correlates with PVR and may improve screening for PH in subjects with COPD.
肺动脉高压（PH）是慢性阻塞性肺疾病（COPD）的常见并发症，会增加发病率和死亡率。目前的超声心动图测量方法对COPD中PH的诊断预测价值较差。通过斑点追踪超声心动图（STE）获得的右心室（RV）应变是心肌变形的一种测量方法，它与肺动脉高压患者的右心室功能和生存率相关。我们假设右心室应变测量在COPD患者中是可行的，并且与有创血流动力学测量相关。对在右心导管插入术48小时内进行超声心动图检查的重度COPD患者的右心室应变值进行回顾性分析。首先，54名受试者纳入分析。分别有31%和57%的受试者可估计右心室收缩压（RVSP）和右心室应变。然后，61%的受试者有以右心室为中心的心尖视图，其中94%可获得右心室应变。右心室游离壁应变与肺血管阻力（PVR）相关（r = 0.41，p = 0.02）。肺血管阻力（PVR）> 3伍德单位（WU）的受试者的右心室游离壁应变值比PVR≤3 WU的受试者更负（更差），中位数应变分别为-20（-23，-12）和-23（-29，-15），p < 0.05。受试者工作特征曲线显示，右心室游离壁应变> -23对识别PVR> 3 WU的敏感性为92%，特异性为44%（曲线下面积0.71）。右心室应变估计在大多数重度COPD受试者中是可行的。右心室应变与PVR相关，可能会改善COPD患者中PH的筛查。
