Chiba Yasuyuki, Iwano Hiroyuki, Kaga Sanae, Shinkawa Mio, Murayama Michito, Ohira Hiroshi, Ishizaka Suguru, Sarashina Miwa, Tsujinaga Shingo, Yokoyama Shinobu, Nakabachi Masahiro, Nishino Hisao, Okada Kazunori, Kamiya Kiwamu, Nagai Toshiyuki, Anzai Toshihisa
Faculty of Medicine and Graduate School of Medicine, Department of Cardiovascular Medicine, Hokkaido University, Sapporo, Japan.
Faculty of Health Sciences, Hokkaido University, Sapporo, Japan.
Pulm Circ. 2021 Jan 20;11(1):2045894020983723. doi: 10.1177/2045894020983723. eCollection 2021 Jan-Mar.
Evaluation of left ventricular filling pressure plays an important role in the clinical management of pulmonary hypertension. However, the accuracy of echocardiographic parameters for the determination of left ventricular filling pressure in the presence of pulmonary vascular lesions has not been fully addressed. We retrospectively investigated 124 patients with pulmonary hypertension due to pulmonary vascular lesions (noncardiac pulmonary hypertension group) and 113 patients with ischemic heart disease (control group) who underwent right heart catheterization and echocardiography. The noncardiac pulmonary hypertension group was subdivided into less-advanced and advanced groups according to median pulmonary vascular resistance. Pulmonary artery wedge pressure was determined as left ventricular filling pressure. As echocardiographic parameters of left ventricular filling pressure, the ratio of early- (E) to late-diastolic transmitral flow velocity (E/A), ratio of E to early-diastolic mitral annular velocity (E/e'), and left atrial volume index were measured. In the less-advanced noncardiac pulmonary hypertension and control groups, positive correlations were observed between pulmonary artery wedge pressure and late-diastolic transmitral flow velocity ( = 0.41, = 0.002 and = 0.71, < 0.001, respectively) and left atrial volume index ( = 0.53, < 0.001 and = 0.41, < 0.001), whereas in the advanced noncardiac pulmonary hypertension group, pulmonary artery wedge pressure was only correlated with left atrial volume index ( = 0.27, = 0.032). In the controls, only pulmonary artery wedge pressure determined E (β = 0.48, < 0.001), whereas both pulmonary artery wedge pressure and pulmonary vascular resistance were independent determinants of E (β = 0.29, < 0.001 and β = -0.28, = 0.001, respectively) in the noncardiac pulmonary hypertension group. In conclusion, in the presence of advanced pulmonary vascular lesions, conventional echocardiographic parameters may not accurately reflect left ventricular filling pressure. Elevated pulmonary vascular resistance would lower the E, even when pulmonary artery wedge pressure is elevated, resulting in blunting of echocardiographic parameters for the detection of elevated left ventricular filling pressure.
评估左心室充盈压在肺动脉高压的临床管理中起着重要作用。然而，在存在肺血管病变的情况下，超声心动图参数用于确定左心室充盈压的准确性尚未得到充分探讨。我们回顾性研究了124例因肺血管病变导致肺动脉高压的患者（非心脏性肺动脉高压组）和113例缺血性心脏病患者（对照组），这些患者均接受了右心导管检查和超声心动图检查。非心脏性肺动脉高压组根据肺血管阻力中位数分为进展较轻组和进展较重组。肺动脉楔压被确定为左心室充盈压。作为左心室充盈压的超声心动图参数，测量了舒张早期（E）与舒张晚期二尖瓣血流速度之比（E/A）、E与舒张早期二尖瓣环速度之比（E/e'）以及左心房容积指数。在进展较轻的非心脏性肺动脉高压组和对照组中，观察到肺动脉楔压与舒张晚期二尖瓣血流速度（分别为r = 0.41，P = 0.002和r = 0.71，P < 0.001）以及左心房容积指数（分别为r = 0.53，P < 0.001和r = 0.41，P < 0.001）之间存在正相关，而在进展较重的非心脏性肺动脉高压组中，肺动脉楔压仅与左心房容积指数相关（r = 0.27，P = 0.032）。在对照组中，只有肺动脉楔压决定E（β = 0.48，P < 0.001），而在非心脏性肺动脉高压组中，肺动脉楔压和肺血管阻力均为E的独立决定因素（分别为β = 0.29，P < 0.001和β = -0.28，P = 0.001）。总之，在存在进展较重的肺血管病变时，传统超声心动图参数可能无法准确反映左心室充盈压。肺血管阻力升高会降低E，即使肺动脉楔压升高，导致用于检测左心室充盈压升高的超声心动图参数钝化。
