Universidade Federal de Minas Gerais - Pós-Graduação Ciências Aplicadas à Saúde do Adulto, Belo Horizonte, MG - Brasil.
Universidade Federal de Minas Gerais - Faculdade de Medicina, Belo Horizonte, MG - Brasil.
Arq Bras Cardiol. 2023 Aug 7;120(7):e20220461. doi: 10.36660/abc.20220461. eCollection 2023.
The transthoracic echocardiogram (TTE) plays a screening role in the diagnostic algorithm of pulmonary hypertension (PH). Studies have shown a significant disagreement between TTE measurements of the systolic pulmonary artery pressure (sPAP) and right atrial pressure (RAP) and those obtained by right heart catheterization (RHC).
To compare TTE measurements of sPAP and RAP with those obtained by RHC in patients being investigated for PH.
Patients referred to a PH reference center with a high or intermediate TTE probability of PH upon admission were submitted to RHC. The agreement between sPAP and RAP from both procedures was assessed through the Bland-Altman test. Differences of up to 10 mmHg for sPAP and 5 mmHg for RAP were considered within the variability of the test. Receiver Operating Characteristic (ROC) curve was constructed to determine the most accurate sPAP and Tricuspid regurgitation maximal velocity (TRV)values associated with the diagnosis of PH by RHC. The adopted level of statistical significance was 5%.
Ninety-five patients were included. The Bland-Altman analysis showed a bias of 8.03 mmHg (95% CI:-34.9-50.9) for sPAP and -3.30 mmHg (95% CI:-15.9-9.3) for RAP. AUC for sPAP and TRV measured by TTE for discrimination of probable PH were 0.936 (95% CI: 0.836-1.0) and 0.919 (95% CI: 0.837-1.0), respectively. However, only 33.4% of the echocardiographic estimate of sPAP and 55.1% of RAP were accurate, as compared to the measurements obtained by RHC.
TTE has a high discriminatory power as a screening diagnostic method for PH despite presenting disagreements between sPAP and RAP absolute values when compared to RHC measurements.
经胸超声心动图（TTE）在肺动脉高压（PH）的诊断算法中起筛查作用。研究表明，TTE 测量的收缩期肺动脉压（sPAP）和右心房压（RAP）与右心导管检查（RHC）获得的值之间存在显著差异。
比较 TTE 测量的 sPAP 和 RAP 与接受 PH 检查的患者的 RHC 测量值。
入院时 TTE 高度或中度提示 PH 的患者被转诊至 PH 参考中心，并接受 RHC。通过 Bland-Altman 检验评估两种方法测量的 sPAP 和 RAP 之间的一致性。sPAP 差异高达 10mmHg，RAP 差异高达 5mmHg 被认为在该试验的可变性范围内。构建受试者工作特征（ROC）曲线，以确定与 RHC 诊断 PH 最相关的 sPAP 和三尖瓣反流最大速度（TRV）值。采用的统计显著性水平为 5%。
共纳入 95 例患者。Bland-Altman 分析显示 sPAP 的偏倚为 8.03mmHg（95%CI：-34.9-50.9），RAP 的偏倚为-3.30mmHg（95%CI：-15.9-9.3）。TTE 测量的 sPAP 和 TRV 用于鉴别可能的 PH 的 AUC 分别为 0.936（95%CI：0.836-1.0）和 0.919（95%CI：0.837-1.0）。然而，与 RHC 测量值相比，只有 33.4%的 sPAP 超声心动图估计值和 55.1%的 RAP 估计值是准确的。
尽管 TTE 测量的 sPAP 和 RAP 绝对值与 RHC 测量值存在差异，但作为 PH 的筛查诊断方法仍具有较高的鉴别能力。
