Saito Naka, Kato Shingo, Saito Noritaka, Nakachi Tatsuya, Fukui Kazuki, Kosuge Masami, Kimura Kazuo
Department of Clinical Laboratory, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan.
Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan.
J Ultrasound Med. 2018 Apr;37(4):891-896. doi: 10.1002/jum.14424. Epub 2017 Sep 29.
The differential diagnosis between precapillary and postcapillary pulmonary hypertension (PH) is important for deciding on the appropriate therapeutic strategy. The aim of this study was to assess whether the atrial volume ratio can differentiate precapillary and post-capillary PH.
Seventy-seven patients with PH who underwent transthoracic echocardiography (TTE) and right heart catheterization were retrospectively studied. Pulmonary hypertension was defined as a mean pulmonary arterial pressure of 25 mm Hg or higher by right heart catheterization. Patients with a pulmonary capillary wedge pressure higher than 15 mm Hg were classified as having postcapillary PH, and patients with a pulmonary capillary wedge pressure of 15 mm Hg or lower were classified as having precapillary PH. The atrial volume ratio derived from TTE was defined as right atrial volume divided by left atrial volume.
Forty-four (57%) of 77 patients had precapillary PH by the right heart catheterization classification. The atrial volume ratio was significantly higher in precapillary PH than in postcapillary PH (1.03 ± 0.69 versus 0.50 ± 0.19; P < .001). The area under the receiver operating characteristic curve of the atrial volume ratio for detecting postcapillary PH was 0.84 (95% confidence interval: 0.75-0.93). Adding the atrial volume ratio to the left ventricular ejection fraction yielded a high area under the curve of 0.90 (95% confidence interval, 0.83-0.96) for distinguishing precapillary and postcapillary PH.
The atrial volume ratio assessed by TTE might be useful for differential diagnosis between precapillary and postcapillary PH.
毛细血管前性和毛细血管后性肺动脉高压（PH）的鉴别诊断对于确定合适的治疗策略至关重要。本研究的目的是评估心房容积比是否能够区分毛细血管前性和毛细血管后性PH。
对77例行经胸超声心动图（TTE）和右心导管检查的PH患者进行回顾性研究。肺动脉高压定义为右心导管检查测得的平均肺动脉压≥25 mmHg。肺毛细血管楔压高于15 mmHg的患者被归类为毛细血管后性PH，肺毛细血管楔压≤15 mmHg的患者被归类为毛细血管前性PH。由TTE得出的心房容积比定义为右心房容积除以左心房容积。
根据右心导管检查分类，77例患者中有44例（57%）为毛细血管前性PH。毛细血管前性PH患者的心房容积比显著高于毛细血管后性PH患者（1.03±0.69比0.50±0.19；P<0.001）。用于检测毛细血管后性PH的心房容积比的受试者工作特征曲线下面积为0.84（95%置信区间：0.75 - 至0.93）。将心房容积比与左心室射血分数相加，用于区分毛细血管前性和毛细血管后性PH的曲线下面积高达0.90（95%置信区间，0.83 - 0.96）。
通过TTE评估的心房容积比可能有助于毛细血管前性和毛细血管后性PH的鉴别诊断。
