Hilde Janne Mykland, Skjørten Ingunn, Hansteen Viggo, Melsom Morten Nissen, Atar Dan, Hisdal Jonny, Humerfelt Sjur, Steine Kjetil
a 1 Department of Cardiology, Oslo University Hospital , Aker , Norway.
e 5 Faculty of Medicine, Institute of Clinical Sciences, University of Oslo , Aker , Norway.
COPD. 2016;13(2):176-85. doi: 10.3109/15412555.2015.1057275. Epub 2016 Feb 25.
We aimed to study whether pulmonary hypertension (PH) and elevated pulmonary vascular resistance (PVR) could be predicted by conventional echo Doppler and novel tissue Doppler imaging (TDI) in a population of chronic obstructive pulmonary disease (COPD) free of LV disease and co-morbidities.
Echocardiography and right heart catheterization was performed in 100 outpatients with COPD. By echocardiography the time-integral of the TDI index, right ventricular systolic velocity (RVSmVTI) and pulmonary acceleration-time (PAAcT) were measured and adjusted for heart rate. The COPD patients were randomly divided in a derivation (n = 50) and a validation cohort (n = 50).
PH (mean pulmonary artery pressure (mPAP) ≥ 25mmHg) and elevated PVR ≥ 2Wood unit (WU) were predicted by satisfactory area under the curve for RVSmVTI of 0.93 and 0.93 and for PAAcT of 0.96 and 0.96, respectively. Both echo indices were 100% feasible, contrasting 84% feasibility for parameters relying on contrast enhanced tricuspid-regurgitation. RVSmVTI and PAAcT showed best correlations to invasive measured mPAP, but less so to PVR. PAAcT was accurate in 90- and 78% and RVSmVTI in 90- and 84% in the calculation of mPAP and PVR, respectively.
Heart rate adjusted-PAAcT and RVSmVTI are simple and reproducible methods that correlate well with pulmonary artery pressure and PVR and showed high accuracy in detecting PH and increased PVR in patients with COPD. Taken into account the high feasibility of these two echo indices, they should be considered in the echocardiographic assessment of COPD patients.
我们旨在研究在无左心室疾病和共病的慢性阻塞性肺疾病（COPD）患者群体中，传统超声多普勒和新型组织多普勒成像（TDI）能否预测肺动脉高压（PH）和肺血管阻力（PVR）升高。
对100例COPD门诊患者进行了超声心动图检查和右心导管检查。通过超声心动图测量TDI指数的时间积分、右心室收缩速度（RVSmVTI）和肺动脉加速时间（PAAcT），并根据心率进行调整。将COPD患者随机分为推导队列（n = 50）和验证队列（n = 50）。
PH（平均肺动脉压（mPAP）≥25mmHg）和PVR升高≥2伍德单位（WU）分别通过RVSmVTI的曲线下面积为0.93和0.93以及PAAcT的曲线下面积为0.96和0.96得到满意预测。两种超声心动图指标的可行性均为100%，而依赖对比增强三尖瓣反流的参数可行性为84%。RVSmVTI和PAAcT与有创测量的mPAP相关性最好，但与PVR的相关性较差。在计算mPAP和PVR时，PAAcT的准确率分别为90%和78%，RVSmVTI的准确率分别为90%和84%。
心率校正后的PAAcT和RVSmVTI是简单且可重复的方法，与肺动脉压和PVR相关性良好，在检测COPD患者的PH和PVR升高方面具有较高准确性。考虑到这两种超声心动图指标的高可行性，在对COPD患者进行超声心动图评估时应予以考虑。
