A simple echocardiographic prediction rule for hemodynamics in pulmonary hypertension.
A simple echocardiographic prediction rule for hemodynamics in pulmonary hypertension.
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DOI：
10.1161/circimaging.112.976654
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发表时间：
2012-11
期刊：
影响因子：
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通讯作者：
Forfia PR
中科院分区：
文献类型：
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作者：
Opotowsky AR;Ojeda J;Rogers F;Prasanna V;Clair M;Moko L;Vaidya A;Afilalo J;Forfia PR
肺动脉高压(PH)的病因多种多样，不同的生理特点要求不同的治疗方法。区分以肺血管阻力(PVR)升高为主的肺血管阻力(PVR)患者和主要由左侧充盈压升高引起的PH患者是至关重要的。我们回顾了一年内在转诊的PH诊所接受经胸超声心动图和右心导管术的108名患者的血流动力学、超声心动图和临床资料。我们推导了一个简单的超声心动图预测规则，以允许血流动力学区分肺血管疾病所致的PH(PHPVD，定义为肺动脉楔压≤15 mm Hg和Pvr>；3WU)。平均年龄6 1.3±14.8岁，μ平均动脉压16.4±7.1 mm Hg，PVR 6.3±4.0WU，符合血流动力学指标者5 2例(48.1%)。得出的预测规则范围为−2~+2，得分较高，提示发生门静脉瓣膜病的概率较高：左房旁道内径+1分或二尖瓣外侧E：E‘>；10存在收缩中期切迹或加速时间+1；−1；左房旁道内径>；4.2 cm；−1。−为2.5、0和+2时，μPVR分别为2.5、4.5和8.1WU，μ为2.5、16.5和10.4 mm Hg。在拥有完整数据的受试者中，PHPVD的AUC值为0.921。≥评分为0分对PHPVD的敏感性为100%，阳性预测值为69.3%，特异性为62.3%。评分为负值的患者均未发生PHPVD。负分和加速时间<100ms的患者PVR正常(μPVR=1.8WU，范围=0.7WU~3.2WU)。我们提出了一种简单的超声心动图预测规则，它准确地定义了PH的血流动力学，有助于改进PH的筛查和重点临床研究，以诊断和处理PH。
Pulmonary hypertension (PH) has diverse causes with heterogeneous physiology compelling distinct management. Differentiating patients with primarily elevated pulmonary vascular resistance (PVR) from those with PH predominantly due to elevated left sided filling pressure is critical. We reviewed hemodynamics, echocardiography, and clinical data for 108 patients seen at a referral PH clinic with transthoracic echocardiogram and right heart catheterization within 1 year. We derived a simple echocardiographic prediction rule to allow hemodynamic differentiation of PH due to pulmonary vascular disease (PHPVD, defined as pulmonary artery wedge pressure (PAWP) ≤ 15mmHg and PVR >3WU). Age averaged 61.3±14.8 years, μPAWP and PVR were 16.4±7.1mmHg and 6.3±4.0WU respectively, and 52 (48.1%) patients fulfilled PHPVD hemodynamic criteria. The derived prediction rule ranged from −2 to +2 with higher scores suggesting higher probability of PHPVD: +1 point for left atrial AP dimension<3.2cm; +1 for presence of a mid-systolic notch or acceleration time<80msec; −1 for lateral mitral E:e′>10; −1 for left atrial AP dimension>4.2cm. PVR increased stepwise with score (for −2, 0 and +2, μPVR were 2.5, 4.5, and 8.1WU) while the inverse was true for PAWP (corresponding μPAWP were 21.5, 16.5 and 10.4mmHg). Among subjects with complete data, the score had an AUC of 0.921 for PHPVD. A score ≥ 0 had 100% sensitivity and 69.3% positive predictive value for PHPVD, with 62.3% specificity. No patients with a negative score had PHPVD. Patients with a negative score and acceleration time >100msec had normal PVR (μPVR=1.8WU, range=0.7–3.2WU). We present a simple echocardiographic prediction rule that accurately defines PH hemodynamics facilitates improved screening and focused clinical investigation for PH diagnosis and management.