从无创多普勒超声心动图信号生成血流动力学压力曲线的可行性。

Feasibility of generating hemodynamic pressure curves from noninvasive Doppler echocardiographic signals.

作者信息

Ensing G, Seward J, Darragh R, Caldwell R

机构信息

Department of Pediatrics, Indiana University, Indianapolis.

出版信息

J Am Coll Cardiol. 1994 Feb;23(2):434-42. doi: 10.1016/0735-1097(94)90431-6.

DOI:10.1016/0735-1097(94)90431-6

PMID:8294698

Abstract

OBJECTIVES

This study was designed to determine the feasibility of Doppler generation of accurate, complete right ventricular and pulmonary artery pressure curves in patients with Doppler-measurable tricuspid and pulmonary regurgitation.

BACKGROUND

Doppler-derived flow velocities have been used to assess right ventricular systolic pressure; pulmonary artery systolic, diastolic and mean pressures, and left ventricular systolic and diastolic pressures. Instantaneous gradient across any area of discrete narrowing is accurately derived using the simplified Bernoulli equation (4V2). Invasive catheterization is currently the only means of generating intracardiac pressure curves. Noninvasively derived pressure curves using Doppler echocardiography would be a considerable advance in the assessment of normal and pathologic cardiac hemodynamics.

METHODS

Right ventricular and pulmonary artery pressure curves were generated in 18 of 22 patients with measurable tricuspid and pulmonary valve regurgitation using superimposition of Doppler-measured tricuspid and pulmonary valve blood flow velocities on an assumed right atrial pressure. Doppler-measured right ventricular and pulmonary artery pressure curves were compared with simultaneous catheterization-measured curves.

RESULTS

Doppler-derived pulmonary artery systolic pressure (Doppler PAP) correlated with simultaneous catheter-measured pulmonary artery pressure (Cath PAP) by the equation Doppler PAP = 0.92(Cath PAP) + 4.5, r = 0.98. Other Doppler-derived pressure measurements that correlated at near identity with the catheterization-measured corresponding measurement include Doppler-derived pulmonary artery mean pressure (Doppler mean PAP) [Doppler mean PAP = 0.85(Cath mean PAP) + 2.6, r = 0.97], and Doppler-derived right ventricular pressure (Doppler RVP) [Doppler RVP = 0.84(Cath measured RVP) + 7.9, r = 0.98]. Doppler-derived pulmonary, artery diastolic pressure (Doppler PAP diast) did not correspond as well in this study [Doppler PAP diast = 0.45(Cath PAP diast) + 6.6, r = 0.83].

CONCLUSIONS

Clinically usable right ventricular and pulmonary artery pressure curves can be derived by superimposing Doppler-measured tricuspid and pulmonary valve blood flow velocities in patients with tricuspid and pulmonary valve regurgitation.

摘要

目的

本研究旨在确定在患有可通过多普勒测量三尖瓣和肺动脉反流的患者中，利用多普勒生成准确、完整的右心室和肺动脉压力曲线的可行性。

背景

多普勒测得的血流速度已被用于评估右心室收缩压、肺动脉收缩压、舒张压和平均压以及左心室收缩压和舒张压。使用简化伯努利方程（4V²）可准确得出离散狭窄区域任何部位的瞬时压差。目前，有创导管插入术是生成心内压力曲线的唯一方法。利用多普勒超声心动图无创得出压力曲线将是评估正常和病理性心脏血流动力学方面的一项重大进展。

方法

在22例可测量三尖瓣和肺动脉瓣反流的患者中，有18例通过将多普勒测得的三尖瓣和肺动脉瓣血流速度叠加在假定的右心房压力上，生成了右心室和肺动脉压力曲线。将多普勒测得的右心室和肺动脉压力曲线与同时进行导管插入术测得的曲线进行比较。

结果

通过多普勒得出的肺动脉收缩压（多普勒肺动脉收缩压）与同时通过导管测得的肺动脉压力（导管肺动脉收缩压）的关系为：多普勒肺动脉收缩压 = 0.92（导管肺动脉收缩压）+ 4.5，r = 0.98。其他通过多普勒得出的压力测量值与导管插入术测得的相应测量值几乎完全一致，包括多普勒得出的肺动脉平均压（多普勒肺动脉平均压）[多普勒肺动脉平均压 = 0.85（导管肺动脉平均压）+ 2.6，r = 0.97]和多普勒得出的右心室压力（多普勒右心室压力）[多普勒右心室压力 = 0.84（导管测得的右心室压力）+ 7.9，r = 0.98]。在本研究中，通过多普勒得出的肺动脉舒张压（多普勒肺动脉舒张压）的对应关系不太理想[多普勒肺动脉舒张压 = 0.45（导管肺动脉舒张压）+ 6.6，r = 0.83]。