危重症患者三尖瓣环平面收缩期位移/二尖瓣环平面收缩期位移比值：右心和左心功能失匹配的指标和心源型肺水肿的危险因素。
Tricuspid annular plane systolic excursion/mitral annular plane systolic excursion ratio in critically ill patients: an index of right- and left-ventricular function mismatch and a risk factor for cardiogenic pulmonary edema.
机构信息
Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1# Shuai Fu Yuan, Dong Cheng District, Beijing, 100730, China.
Department of Health Care, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
出版信息
BMC Anesthesiol. 2023 May 22;23(1):175. doi: 10.1186/s12871-023-02142-9.
BACKGROUND
This study aimed to explore whether the tricuspid annular systolic excursion (TAPSE)/mitral annular systolic excursion (MAPSE) ratio was associated with the occurrence of cardiogenic pulmonary edema (CPE) in critically ill patients.
MATERIALS AND METHODS
This was a prospective observational study conducted in a tertiary hospital. Adult patients admitted to the intensive care unit who were on mechanical ventilation or in need of oxygen therapy were prospectively screened for enrolment. The diagnosis of CPE was determined based on lung ultrasound and echocardiography findings. TAPSE ≥ 17 mm and MAPSE ≥ 11 mm were used as normal references.
RESULTS
Among the 290 patients enrolled in this study, 86 had CPE. In the logistic regression analysis, the TASPE/MAPSE ratio was independently associated with the occurrence of CPE (odds ratio 4.855, 95% CI: 2.215-10.641, p < 0.001). The patients' heart function could be categorized into four types: normal TAPSE in combination with normal MAPSE (TAPSE↑/MAPSE↑) (n = 157), abnormal TAPSE in combination with abnormal MAPSE (TAPSE↓/MAPSE↓) (n = 40), abnormal TAPSE in combination with normal MAPSE (TAPSE↓/MAPSE↑) (n = 50) and normal TAPSE in combination with abnormal MAPSE (TAPSE↑/MAPSE↓) (n = 43). The prevalence of CPE in patients with TAPSE↑/MAPSE↓ (86.0%) was significantly higher than that in patients with TAPSE↑/MAPSE↑ (15.3%), TAPSE↓/MAPSE↓ (37.5%), or TAPSE↓/MAPSE↑ (20.0%) (p < 0.001). The ROC analysis showed that the area under the curve for the TAPSE/MAPSE ratio was 0.761 (95% CI: 0.698-0.824, p < 0.001). A TAPSE/MAPSE ratio of 1.7 allowed the identification of patients at risk of CPE with a sensitivity of 62.8%, a specificity of 77.9%, a positive predictive value of 54.7% and a negative predictive value of 83.3%.
CONCLUSIONS
The TAPSE/MAPSE ratio can be used to identify critically ill patients at higher risk of CPE.
背景
本研究旨在探讨三尖瓣环收缩期位移（TAPSE）/二尖瓣环收缩期位移（MAPSE）比值与危重症患者心源性肺水肿（CPE）的发生是否相关。
材料与方法
这是一项在三级医院进行的前瞻性观察性研究。前瞻性筛选入住重症监护病房、接受机械通气或需要氧疗的成年患者入组。CPE 的诊断基于肺部超声和超声心动图结果。TAPSE≥17mm 和 MAPSE≥11mm 被用作正常参考。
结果
本研究共纳入 290 例患者，其中 86 例发生 CPE。在逻辑回归分析中，TASPE/MAPSE 比值与 CPE 的发生独立相关（比值比 4.855，95%CI：2.215-10.641，p<0.001）。患者的心功能可分为以下四种类型：TAPSE 正常合并 MAPSE 正常（TAPSE↑/MAPSE↑）（n=157）、TAPSE 异常合并 MAPSE 异常（TAPSE↓/MAPSE↓）（n=40）、TAPSE 异常合并 MAPSE 正常（TAPSE↓/MAPSE↑）（n=50）和 TAPSE 正常合并 MAPSE 异常（TAPSE↑/MAPSE↓）（n=43）。TAPSE↑/MAPSE↓患者（86.0%）的 CPE 患病率明显高于 TAPSE↑/MAPSE↑（15.3%）、TAPSE↓/MAPSE↓（37.5%）或 TAPSE↓/MAPSE↑（20.0%）患者（p<0.001）。ROC 分析显示，TAPSE/MAPSE 比值的曲线下面积为 0.761（95%CI：0.698-0.824，p<0.001）。TAPSE/MAPSE 比值为 1.7 时，可识别出 CPE 风险较高的患者，其敏感性为 62.8%，特异性为 77.9%，阳性预测值为 54.7%，阴性预测值为 83.3%。
结论
TAPSE/MAPSE 比值可用于识别 CPE 风险较高的危重症患者。
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