Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 106 Zhongshan Er Road, Guangzhou, Guangdong Province, 510100, China.
Shantou University Medical College, Shantou, Guangdong Province, China.
BMC Pulm Med. 2024 Jun 28;24(1):306. doi: 10.1186/s12890-024-03113-7.
For patients with congenital heart disease-related pulmonary arterial hypertension (CHD-PAH), cardiopulmonary exercise testing (CPET) can reflect cardiopulmonary reserve function. However, CPET may not be readily accessible for patients with high-risk conditions or limited mobility due to disability. Echocardiography, on the other hand, serves as a widely available diagnostic tool for all CHD-PAH patients. This study was aimed to identify the parameters of echocardiography that could serve as indicators of cardiopulmonary function and exercise capacity.
A cohort of 70 patients contributed a total of 110 paired echocardiogram and CPET results to this study, with 1 year interval for repeated examinations. Echocardiography and exercise testing were conducted following standardized procedures, and the data were collected together with clinically relevant indicators for subsequent statistical analysis. Demographic comparisons were performed using t-tests and chi-square tests. Univariate and multivariate analyses were conducted to identify potential predictors of peak oxygen uptake (peak VO) and the carbon dioxide ventilation equivalent slope (VE/VCO slope). Receiver operating characteristic (ROC) analysis was used to assess the performance of the parameters.
The ratio of tricuspid annular plane systolic excursion to pulmonary artery systolic pressure (TAPSE/PASP) was found to be the only independent indicator significantly associated with both peak VO and VE/VCO slope (both p < 0.05). Additionally, left ventricular ejection fraction (LVEF) and right ventricular fractional area change (FAC) were independently correlated with the VE/VCO slope (both p < 0.05). TAPSE/PASP showed the highest area under the ROC curve (AUC) for predicting both a peak VO ≤ 15 mL/kg/min and a VE/VCO slope ≥ 36 (AUC = 0.91, AUC = 0.90, respectively). The sensitivity and specificity of TAPSE/PASP at the optimal threshold exceeded 0.85 for both parameters.
TAPSE/PASP may be a feasible echocardiographic indicator for evaluating exercise tolerance.
对于患有先天性心脏病相关肺动脉高压（CHD-PAH）的患者，心肺运动测试（CPET）可以反映心肺储备功能。然而，对于因高风险状况或残疾导致行动不便的患者，CPET 可能无法轻易进行。另一方面，超声心动图是所有 CHD-PAH 患者广泛可用的诊断工具。本研究旨在确定超声心动图的参数，这些参数可以作为心肺功能和运动能力的指标。
本研究共纳入 70 例患者，共 110 对超声心动图和 CPET 结果，间隔 1 年重复检查。超声心动图和运动测试按照标准程序进行，收集数据并与临床相关指标一起进行后续统计分析。使用 t 检验和卡方检验进行人口统计学比较。进行单变量和多变量分析，以确定峰值摄氧量（peak VO）和二氧化碳通气当量斜率（VE/VCO 斜率）的潜在预测因素。使用接收者操作特征（ROC）分析评估参数的性能。
三尖瓣环平面收缩期位移与肺动脉收缩压的比值（TAPSE/PASP）是唯一与 peak VO 和 VE/VCO 斜率均显著相关的独立指标（均 p<0.05）。此外，左心室射血分数（LVEF）和右心室分数面积变化（FAC）与 VE/VCO 斜率独立相关（均 p<0.05）。TAPSE/PASP 预测 peak VO≤15 mL/kg/min 和 VE/VCO 斜率≥36 的 ROC 曲线下面积（AUC）最高（AUC=0.91，AUC=0.90）。TAPSE/PASP 在最佳阈值下对这两个参数的灵敏度和特异性均超过 0.85。
TAPSE/PASP 可能是评估运动耐量的一种可行的超声心动图指标。
