Accuracy of Doppler-Derived Estimation of Pulmonary Vascular Resistance in Congenital Heart Disease: An Index of Operability
Accuracy of Doppler-Derived Estimation of Pulmonary Vascular Resistance in Congenital Heart Disease: An Index of Operability
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DOI：
10.1007/s00246-011-0035-4
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发表时间：
2011-12-01
影响因子：
1.6
通讯作者：
Soltani, Manoucher
中科院分区：
文献类型：
--
作者：
Ajami, Gholam Hossein;Cheriki, Sirous;Soltani, Manoucher
肺血管阻力（PVR）是先天性心脏病（CHD）合并肺动脉高压（PAH）患者评估和选择治疗方式时关键且重要的参数。心导管插入术是“金标准”，但却是 PVR 测量的一种侵入性方法。在过去的几十年里，一种无创且可靠的儿童 PVR 估计方法一直是一项重大挑战，也是人们最需要的方法，特别是对于那些需要重复测量的人来说。在一项前瞻性研究中，在连续进行心导管检查的患者中，PVR 计算为 20 名 CHD 和高 PAH 患者的跨肺压力梯度（匕首 P）与肺流量 (QP) 的比率。随后，通过多普勒超声心动图衍生指数对这些患者进行无创性 PVR 评估，该指数定义为三尖瓣反流速度 (TRVm/s) 与右心室流出道 (RVOT) 速度时间积分 (VTIcm) 的比率。插管时测量的 PVR (PVRcath) 与 TRV/VTIm 比值之间存在良好的相关性； VTI (VTIm) 的三次测量的平均值，其中 R (2) = 0.53 (p = 0.008)。此外，TRV/VTIm 值为 0.2 时，PVR > 6 Woods 单位 (WU) 的敏感性为 71.4%，特异性为 100%，PVR 等于 8 WU 的敏感性为 90%，特异性为 90%。通过导管插入使 PVR 值在 6 至 8 WU 之间被认为是对患有左向右分流和 PAH 的儿童进行干预的分界点。总之，多普勒衍生的 TRV/VTIm 比值是一个可靠的指标，可能有助于作为 PAH 和 PVR 增加患者的治疗方式选择和随访的补充诊断工具。
Pulmonary vascular resistance (PVR) is a critical and essential parameter during the assessment and selection of modality of treatment in patients with congenital heart disease (CHD) accompanied by pulmonary arterial hypertension (PAH). Cardiac catheterization is the "gold standard" but is an invasive method for PVR measurement. A noninvasive and reliable method for estimation of PVR in children has been a major challenge and most desirable during past decades, especially for those who need repeated measurements. In a prospective study and among consecutive patients who were referred for cardiac catheterizations, PVR was calculated as the ratio of the transpulmonary pressure gradient (a dagger P) to the amount of the pulmonary flow (QP) accordingly for 20 patients with CHD and high PAH. Subsequently and noninvasively, PVR was assessed for these patients by a Doppler echocardiography-derived index defined as the ratio of the tricuspid regurgitation velocity (TRVm/s) to the velocity time integral (VTIcm) of the right-ventricular outflow tract (RVOT). There was a good correlation between PVR measured at catheterization (PVRcath) and TRV/VTIm ratio; the mean of three measurements of VTI (VTIm) with R (2) = 0.53 (p = 0.008). In addition, a TRV/VTIm value of 0.2 provided a sensitivity of 71.4% and a specificity of 100% for PVR > 6 Woods units (WU) as well as sensitivity of 90% and specificity of 90% for a PVR equal to 8 WU. PVR value between 6 and 8 WU by catheterization has been considered as a cut-off point for intervention in children with left-to-right shunts and PAH. In conclusion, Doppler-derived TRV/VTIm ratio is a reliable index that may be helpful as a supplementary diagnostic tool for the selection of modality of treatment and follow-up of patients with PAH and increased PVR.