Zhao Qin-Hua, Wang Lan, Pudasaini Bigyan, Jiang Rong, Yuan Ping, Gong Su-Gang, Guo Jian, Xiao Qiang, Liu Hui, Wu Cheng, Jing Zhi-Cheng, Liu Jin-Ming
Department of Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China.
Department of Pulmonary Function, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China.
Clin Cardiol. 2017 Feb;40(2):95-101. doi: 10.1002/clc.22635. Epub 2016 Nov 2.
Doppler echocardiography is usually the first diagnostic investigation for patients suspected with pulmonary hypertension (PH), but it is often inaccurate when used alone, especially in mild PH.
Cardiopulmonary exercise testing (CPET) may serve as a complementary tool to improve diagnostic accuracy in echocardiography-suspected "PH possible" patients.
Eighty-eight consecutive patients with suspected PH (referred to as "PH possible" hereafter) based on echocardiography were included in the study. CPET was assessed subsequently and PH was confirmed by right-heart catheterization in all subjects. We analyzed CPET data from patients and derived a CPET prediction rule to hemodynamically differentiate PH.
Eighty-eight patients (27 patients with confirmed PH, and PH ruled out in 61 patients) were included in the study. Compared with non-PH patients, the PH subjects had lower peak oxygen uptake (VO ), aerobic capacity (AT), peak partial pressure of end-tidal CO (P CO ), oxygen uptake efficiency plateau (OUEP), and oxygen uptake efficiency slope (OUES), along with higher minute ventilation (VE)/carbon dioxide output (VCO ) slope and lowest VE/VCO (P < 0.001). VE/VCO slope and AT were independent predictors of PH derived from multivariate logistic regression adjusted for age and body mass index. A score combining VE/VCO slope and AT reached a high area under the curve value of 0.98. A score ≥0.5 had 95% specificity and 92.6% sensitivity for diagnosis of PH.
A score combining VE/VCO slope and AT provides high specificity in screening out PH from a pool of echocardiography-suspected PH patients.
对于疑似肺动脉高压（PH）的患者，多普勒超声心动图通常是首选的诊断检查方法，但单独使用时往往不准确，尤其是在轻度PH患者中。
心肺运动试验（CPET）可作为一种辅助工具，提高对超声心动图怀疑为“可能患有PH”患者的诊断准确性。
本研究纳入了连续88例基于超声心动图怀疑患有PH（以下简称“可能患有PH”）的患者。随后对其进行CPET评估，并通过右心导管检查确诊所有受试者的PH情况。我们分析了患者的CPET数据，并推导了用于血流动力学鉴别PH的CPET预测规则。
本研究纳入了88例患者（27例确诊为PH，61例排除PH）。与非PH患者相比，PH患者的峰值摄氧量（VO）、有氧运动能力（AT）、呼气末二氧化碳分压峰值（P CO）、摄氧效率平台期（OUEP）和摄氧效率斜率（OUES）较低，同时分钟通气量（VE）/二氧化碳排出量（VCO）斜率较高，最低VE/VCO较低（P < 0.001）。经年龄和体重指数校正的多因素逻辑回归分析显示，VE/VCO斜率和AT是PH的独立预测因素。结合VE/VCO斜率和AT的评分曲线下面积高达0.98。评分≥0.5对PH诊断的特异性为95%，敏感性为92.6%。
结合VE/VCO斜率和AT的评分在从超声心动图怀疑患有PH的患者中筛查出PH方面具有较高的特异性。
