Haddad K A, Lebeau R, Tremblay G
Acta Cardiol. 1981;36(1):21-34.
There are few data regarding the sensitivity and specificity of the pulmonic valve echogram in the detection of pulmonary hypertension (PHT). In the present study, simultaneous pulmonic echograms were evaluated in 40 patients with normal pulmonary artery pressure and 24 with PHT (mean pressure greater than 20 mmHg). The A wave depth (Amax) was 4.0 plus or minus 1 mm (2-6 mm) in normals but was (1.05 plus or minus 0.2 mm) (p less than 0,001) in PHT and was absent in 5 of 24 PHT patients with a mean pulmonary artery pressure (MPAP) greater than or equal to 35 mm. The ef slope in normals was 22 plus or minus 1.8 mm and 7.1 plus or minus 2 mm (p less than 0.01) in patients with PHT. A negative slope was observed in 4 patients with severe PHT (MPAP) greater than or equal to 40 mm, but never in normals or in patients with mild PHT. The opening velocity (OV) was significantly higher in PHT patients 363.2 plus or minus 19.3 verus 293 plus or minus 7.3 mm/sec (p less than 0.01). Normal values were found in patients with moderate to severe PHT but an OV greater than or equal to 450 mm/sec was not encountered within the normal group. A mid-systolic notch was observed in 10 patients with PHT of which 9 with a MPAP greater than or equal to 35 mmHg. The maximum systolic excursion of the pulmonary valve in both groups did not differ significantly (13.3 plus or minus 0.5 vs 12.8 plus or minus 0.3). Even less specific, the systolic intervals (PEP/ET), were raised greater than or equal to 0.30 in 12 out of 15 with PHT. In conclusion, the reduction or disappearance of Amax with sinus rhythm, a flattening or negativation of ef slope and the presence of a mid-systolic notch were found to be the 3 most reliable criteria to detect and quantify PHT.
关于肺动脉瓣超声心动图在检测肺动脉高压（PHT）方面的敏感性和特异性的数据较少。在本研究中，对40例肺动脉压力正常的患者和24例肺动脉高压患者（平均压力大于20 mmHg）进行了同步肺动脉超声心动图评估。正常情况下A波深度（Amax）为4.0±1 mm（2 - 6 mm），但在肺动脉高压患者中为（1.05±0.2 mm）（p＜0.001），在24例平均肺动脉压（MPAP）大于或等于35 mmHg的肺动脉高压患者中有5例A波消失。正常情况下ef斜率为22±1.8 mm，在肺动脉高压患者中为7.1±2 mm（p＜0.01）。在4例重度肺动脉高压（MPAP大于或等于40 mmHg）患者中观察到负斜率，但在正常人和轻度肺动脉高压患者中从未观察到。肺动脉高压患者的开放速度（OV）显著更高，为363.2±19.3 对293±7.3 mm/秒（p＜0.01）。中度至重度肺动脉高压患者的数值正常，但在正常组中未遇到开放速度大于或等于450 mm/秒的情况。在10例肺动脉高压患者中观察到收缩中期切迹，其中9例MPAP大于或等于35 mmHg。两组肺动脉瓣的最大收缩期偏移无显著差异（13.3±0.5对12.8±0.3）。特异性更低的是，15例肺动脉高压患者中有12例的收缩间期（PEP/ET）升高至大于或等于0.30。总之，发现窦性心律时Amax降低或消失、ef斜率变平或变为负值以及存在收缩中期切迹是检测和量化肺动脉高压的3个最可靠标准。
