Augustine Daniel X, Coates-Bradshaw Lindsay D, Willis James, Harkness Allan, Ring Liam, Grapsa Julia, Coghlan Gerry, Kaye Nikki, Oxborough David, Robinson Shaun, Sandoval Julie, Rana Bushra S, Siva Anjana, Nihoyannopoulos Petros, Howard Luke S, Fox Kevin, Bhattacharyya Sanjeev, Sharma Vishal, Steeds Richard P, Mathew Thomas
Royal United Hospital Bath NHS Foundation Trust, Bath, UK.
Nottingham University Hospitals NHS Trust, Nottingham, UK.
Echo Res Pract. 2018 Sep;5(3):G11-G24. doi: 10.1530/ERP-17-0071.
Pulmonary hypertension is defined as a mean arterial pressure of ≥25 mmHg as confirmed on right heart catheterisation. Traditionally, the pulmonary arterial systolic pressure has been estimated on echo by utilising the simplified Bernoulli equation from the peak tricuspid regurgitant velocity and adding this to an estimate of right atrial pressure. Previous studies have demonstrated a correlation between this estimate of pulmonary arterial systolic pressure and that obtained from invasive measurement across a cohort of patients. However, for an individual patient significant overestimation and underestimation can occur and the levels of agreement between the two is poor. Recent guidance has suggested that echocardiographic assessment of pulmonary hypertension should be limited to determining the probability of pulmonary hypertension being present rather than estimating the pulmonary artery pressure. In those patients in whom the presence of pulmonary hypertension requires confirmation, this should be done with right heart catheterisation when indicated. This guideline protocol from the British Society of Echocardiography aims to outline a practical approach to assessing the probability of pulmonary hypertension using echocardiography and should be used in conjunction with the previously published minimum dataset for a standard transthoracic echocardiogram.
肺动脉高压定义为经右心导管检查确认平均动脉压≥25 mmHg。传统上,肺动脉收缩压是通过超声心动图利用简化的伯努利方程从三尖瓣反流峰值速度估算得出,并将其与右心房压力估算值相加。既往研究已证实,在一组患者中,这种肺动脉收缩压估算值与有创测量值之间存在相关性。然而,对于个体患者,可能会出现显著的高估和低估,且两者之间的一致性较差。近期指南建议,超声心动图对肺动脉高压的评估应限于确定肺动脉高压存在的可能性,而非估算肺动脉压力。对于那些需要确认是否存在肺动脉高压的患者,如有指征,应通过右心导管检查来完成。英国超声心动图学会的本指南方案旨在概述一种使用超声心动图评估肺动脉高压可能性的实用方法,应与先前公布的标准经胸超声心动图最小数据集结合使用。