Haddad Ali, Tsarenko Olga, Szalai Cynthia, Mohamed Ahmed, Hochreiter Marcel, Berger Marc Moritz, Schmack Bastian, Ruhparwar Arjang, Brenner Thorsten, Shehada Sharaf-Eldin
Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany.
Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Canter, University Hospital Essen, University Duisburg-Essen, 45141 Essen, Germany.
Rev Cardiovasc Med. 2022 Jun 28;23(7):245. doi: 10.31083/j.rcm2307245. eCollection 2022 Jul.
Pulmonary hypertension (PH) is common in patients with left-side valvular diseases, especially with mitral regurgitation (MR). Measurement using pulmonal artery catheter (PAC) is the gold standard to asses pulmonary vascular pressures. During mitral valve surgery echocardiography is routinely used for valvular management and to evaluate pulmonary hemodynamic. The accuracy of echocardiographic measurements is controversial in the literature. We aimed to evaluate the reliability and accuracy of the noninvasive measurement for systolic pulmonary artery pressure (SPAP) using Doppler echocardiography compared to the invasive measurement using PAC in patients presenting with MR undergoing surgery.
This prospective observational study evaluated 146 patients with MR undergoing cardiac surgery between 09/2020 and 10/2021. All patients underwent simultaneous SPAP assessment by PAC and transesophageal echocardiography at three different time points: before heart-lung-machine (HLM), after weaning from HLM and at the end of surgery.
Mean patients' age was 61 11.5 years, and 51 (35%) patients were female. Most of patients presented with severe MR (n = 126; 86.3%) or endocarditis (n = 18; 12.3%). Patients underwent either isolated mitral valve surgery (n = 65; 44.5%) or mitral valve surgery combined with other surgeries (n = 81; 55.5%). Mean SPAP was underestimated by transesophageal echocardiographic measurement in comparison to PAC measurement before HLM (41.9 13.1 mmHg vs. 44.8 13.8 mmHg, 0.001), after weaning from HLM (37.6 9.3 mmHg vs. 42.4 10.1 mmHg, 0.001), and at the end of surgery (35.6 9.1 mmHg vs. 39.9 9.9 mmHg, 0.001). This difference remained within the sub-analysis in patients presented with moderate or severe PH during all the time points. Bland-Altman analysis showed that transesophageal echocardiographic measurement underestimate SPAP in comparison to PAC as these two approaches are significantly different from one another.
In patients presented with MR, transesophageal Doppler echocardiography could asses the presence of PH with high probability. This assessment is however underestimated and the use of PAC in those patients to diagnose, classify and monitor the therapy of PH remains recommended if required.
肺动脉高压（PH）在左侧瓣膜疾病患者中很常见，尤其是二尖瓣反流（MR）患者。使用肺动脉导管（PAC）进行测量是评估肺血管压力的金标准。在二尖瓣手术期间，超声心动图常规用于瓣膜管理和评估肺血流动力学。超声心动图测量的准确性在文献中存在争议。我们旨在评估在接受手术的MR患者中，与使用PAC进行的有创测量相比，使用多普勒超声心动图对收缩期肺动脉压（SPAP）进行无创测量的可靠性和准确性。
这项前瞻性观察性研究评估了2020年9月至2021年10月期间接受心脏手术的146例MR患者。所有患者在三个不同时间点同时通过PAC和经食管超声心动图进行SPAP评估：心肺转流（HLM）前、HLM脱机后和手术结束时。
患者平均年龄为61±11.5岁，51例（35%）为女性。大多数患者表现为重度MR（n = 126；86.3%）或心内膜炎（n = 18；12.3%）。患者接受单纯二尖瓣手术（n = 65；44.5%）或二尖瓣手术联合其他手术（n = 81；55.5%）。与HLM前PAC测量相比，经食管超声心动图测量低估了平均SPAP（41.9±13.1 mmHg对44.8±13.8 mmHg，P<0.001），HLM脱机后（37.6±9.3 mmHg对42.4±10.1 mmHg，P<0.001），以及手术结束时（35.6±9.1 mmHg对39.9±9.9 mmHg，P<0.001）。在所有时间点的中度或重度PH患者亚分析中，这种差异仍然存在。Bland-Altman分析表明，与PAC相比，经食管超声心动图测量低估了SPAP，因为这两种方法彼此有显著差异。
在MR患者中，经食管多普勒超声心动图很可能能够评估PH的存在。然而，这种评估被低估了，如果需要，仍建议在这些患者中使用PAC来诊断、分类和监测PH的治疗。
