Serra Walter, Chetta Alfredo
Cardiology Division, Cardio-Thoracic and Vascular Department, University Hospital, University of Parma, 43121 Parma, Italy.
Department of Medicine and Surgery, University Hospital, University of Parma, 43121 Parma, Italy.
Pathophysiology. 2022 Mar 15;29(1):134-142. doi: 10.3390/pathophysiology29010012.
In pulmonary hypertension (PH), the development of right ventricular (RV) dilatation and RV failure are signs of accelerated progression of the disease, resulting in an increased risk of cardiac death. Even the noninvasive assessment of systolic blood pressure in the pulmonary artery undertaken by echocardiography does not provide a measure of ventricle-pulmonary interaction. Some studies have shown the potential for echocardiography to indirectly evaluate pulmonary vascular resistance (PVR) and the acceleration time of pulmonary outflow (PAAT). We used systolic pulmonary artery pressure (sPAP) and pulmonary vascular resistance to develop an sPAP/PAAT ratio (strength/surface unit)/(time) for this study. From January 2017 to December 2018, 60 healthy subjects and 63 patients with systemic scleroderma (Ssc) (60 females, 3 males), 27 with PH and 36 without PH at two-dimensional echocardiographic/Doppler, were screened. In normal subjects, the mean sPAP/PAAT ratio was 0.26 ± 0.063, which indicated optimal pulmonary arterial ventricle coupling and biventricular function. The data derived from the analysis of the Ssc patients showed that those presenting pre-capillary PH at cardiac catheterization had an sPAP/PAAT ratio of 0.40 ± 0.05. There was a significant correlation between sPAP/PAAT with Walk Distance (WD) and PVR, but not with TAPSE. Interobserver variability was less than 5%. The sPAP/PAAT ratio is a new parameter that may indicate pulmonary vascular afterload and interaction, both in normal subjects and in patients with Ssc and PH.
在肺动脉高压（PH）中，右心室（RV）扩张和RV衰竭的发生是疾病加速进展的迹象，会导致心源性死亡风险增加。即使通过超声心动图对肺动脉收缩压进行无创评估，也无法衡量心室与肺之间的相互作用。一些研究表明，超声心动图有可能间接评估肺血管阻力（PVR）和肺流出加速时间（PAAT）。在本研究中，我们使用收缩期肺动脉压（sPAP）和肺血管阻力得出了一个sPAP/PAAT比值（力/面积单位）/时间。从2017年1月至2018年12月，对60名健康受试者和63例系统性硬化症（Ssc）患者（60名女性，3名男性）进行了筛查，其中27例在二维超声心动图/多普勒检查中有PH，36例无PH。在正常受试者中，平均sPAP/PAAT比值为0.26±0.063，这表明肺动脉心室耦合和双心室功能最佳。对Ssc患者的分析数据显示，那些在心脏导管检查中表现为毛细血管前PH的患者，其sPAP/PAAT比值为0.40±0.05。sPAP/PAAT与步行距离（WD）和PVR之间存在显著相关性，但与三尖瓣环平面收缩期位移（TAPSE）无关。观察者间变异性小于5%。sPAP/PAAT比值是一个新的参数，可能表明正常受试者以及Ssc和PH患者的肺血管后负荷及相互作用。
