Mansour Amr, Roushdy Alaa, Harb Bahaaeldin, Attia Heba
Department of Cardiology, Ain Shams University, Cairo, Egypt.
Department of Cardiology, National Heart Institute, Giza, Egypt.
J Cardiovasc Echogr. 2020 Oct-Dec;30(4):193-200. doi: 10.4103/jcecho.jcecho_41_20. Epub 2021 Jan 20.
Pulmonary hypertension (PH) with congenital heart disease (CHD) affects the functional capacity (FC), quality of life, and survival. However, the importance of different echocardiographic parameters and their correlation with FC is unclear.
A custom-made sheet for 34 consecutive patients with PH due to CHD was made to include patient's demographic data, underlying cardiac disorder, and FC by 6-min walk test (6MWT). The patients were subdivided into Group 1 with 6MWT < 330 m and Group 2 with 6MWT > 330 m. A cutoff value of 330 m was selected because it reflected the survival and outcome of patients in many studies before. Left ventricle global radial strain, baseline saturation, and saturation after 6MWT showed a significant strong positive correlation with 6MWT ( = 0.755, 0.714, and 0.721, = 0.001, 0.000, and 0.000, respectively). Multiple regression analysis using a multivariate model showed that the mean pulmonary artery pressure (MPAP) and baseline saturation are the most independent predictors of the FC ( = 0.028 and 0.049, respectively), with a cutoff point for MPAP > 30 mmHg (area under the curve [AUC]: 0.85) with a sensitivity and specificity of 69.23% and 95.24%, respectively, and cutoff point for saturation < 94% (AUC: 0.852) with a sensitivity and specificity of 92.31% and 76.19%, respectively.
The MPAP and the baseline oxygen saturation were the most independent predictors of impaired FC. They can be used for risk stratification and as surrogate predictors of outcome in this group of patients.
先天性心脏病（CHD）相关的肺动脉高压（PH）会影响功能能力（FC）、生活质量和生存率。然而，不同超声心动图参数的重要性及其与FC的相关性尚不清楚。
为34例因CHD导致PH的连续患者制作了一份定制表格，内容包括患者的人口统计学数据、潜在心脏疾病以及通过6分钟步行试验（6MWT）测得的FC。患者被分为两组，6MWT＜330米的为第1组，6MWT＞330米的为第2组。选择330米作为临界值是因为它在之前的许多研究中反映了患者的生存情况和预后。左心室整体径向应变、基线饱和度以及6MWT后的饱和度与6MWT呈显著强正相关（分别为r = 0.755、0.714和0.721，P = 0.001、0.000和0.000）。使用多变量模型进行的多元回归分析表明，平均肺动脉压（MPAP）和基线饱和度是FC最独立的预测指标（分别为P = 0.028和0.049），MPAP＞30 mmHg的临界值（曲线下面积面积面积面积[AUC]：0.85），敏感性和特异性分别为69.23%和95.24%，饱和度＜94%的临界值（AUC：0.852），敏感性和特异性分别为92.31%和76.19%。
MPAP和基线氧饱和度是FC受损最独立的预测指标。它们可用于该组患者的风险分层以及作为预后的替代预测指标。
