Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA,
Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.
Cardiology. 2020;145(11):703-709. doi: 10.1159/000510348. Epub 2020 Oct 8.
In patients with pulmonary hypertension (PHT), the assessment of left ventricular (LV) diastolic function by echocardiography may not be reliable. PHT can affect Doppler parameters of LV diastolic function such as mitral inflow velocities and mitral annular velocities. The current guidelines for the assessment of LV diastolic function do not recommend specific adjustments for patients with PHT.
We analyzed 36 patients from the PHT clinic that had an echocardiogram and right heart catheterization performed within 6 months of each other. Early mitral inflow velocity (E), lateral mitral annular velocity (lateral e'), septal mitral annular velocity (septal e'), tricuspid free wall annular velocity (RV e') were measured and compared to the invasively measured intracardiac pressures including pulmonary capillary wedge pressure (PCWP), mean pulmonary artery pressure, and right ventricular end-diastolic pressure.
Among patients with PHT, the specificity of the septal e' for LV diastolic dysfunction was 0.19, and the positive predictive value was 0.13 (lower than the lateral e' or E/average e'). By receiver-operating characteristic curve analysis, the area under the curve (AUC) of lateral and septal e' was just 0.64 (p = 0.9) and 0.53 (p = 0.6), respectively, while the AUC of average E/e' was 0.94 (p < 0.001). The septal e' was paradoxically lower at 6.5 ± 1.9 cm/s for normal PCWP compared to 6.9 ± 1.7 cm/s for elevated PCWP (p = 0.04). 81 versus 40% (p = 0.017) of patients with normal versus elevated PCWP had an abnormal septal e' <7 cm/s. By linear regression, there was no correlation between the Doppler parameters of LV diastolic function and the PCWP.
Our study suggests E/average e' may be the only reliable tissue Doppler parameter of LV diastolic dysfunction in patients with PHT, and that septal e' is paradoxically decreased in patients with PHT and normal left-sided filling pressures.
在肺动脉高压（PHT）患者中，超声心动图评估左心室（LV）舒张功能可能不可靠。PHT 可影响 LV 舒张功能的多普勒参数，如二尖瓣血流速度和二尖瓣环速度。目前评估 LV 舒张功能的指南不建议对 PHT 患者进行特定调整。
我们分析了在彼此 6 个月内进行了超声心动图和右心导管检查的 36 名来自 PHT 诊所的患者。测量了早期二尖瓣血流速度（E）、外侧二尖瓣环速度（外侧 e'）、间隔二尖瓣环速度（间隔 e'）、三尖瓣游离壁环速度（RV e'），并与包括肺毛细血管楔压（PCWP）、平均肺动脉压和右心室舒张末期压在内的侵入性测量心内压进行比较。
在 PHT 患者中，间隔 e'对 LV 舒张功能障碍的特异性为 0.19，阳性预测值为 0.13（低于外侧 e'或 E/平均 e'）。通过接收者操作特征曲线分析，外侧和间隔 e'的曲线下面积（AUC）分别为 0.64（p = 0.9）和 0.53（p = 0.6），而平均 E/e'的 AUC 为 0.94（p < 0.001）。对于正常 PCWP，间隔 e'为 6.5 ± 1.9 cm/s，而对于升高的 PCWP，间隔 e'为 6.9 ± 1.7 cm/s，这是反常的（p = 0.04）。与正常 PCWP 相比，81%与 40%（p = 0.017）的患者间隔 e'＜7 cm/s 异常。通过线性回归，LV 舒张功能的多普勒参数与 PCWP 之间没有相关性。
我们的研究表明，E/平均 e'可能是 PHT 患者 LV 舒张功能障碍的唯一可靠组织多普勒参数，并且在 PHT 合并正常左侧充盈压的患者中，间隔 e'反常降低。
