Pulmonary Artery Acceleration Time Provides a Reliable Estimate of Invasive Pulmonary Hemodynamics in Children
Pulmonary Artery Acceleration Time Provides a Reliable Estimate of Invasive Pulmonary Hemodynamics in Children
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DOI：
10.1016/j.echo.2016.08.013
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发表时间：
2016-11-01
影响因子：
6.5
通讯作者：
Singh, Gautam K.
中科院分区：
文献类型：
--
作者：
Levy, Philip T.;Patel, Meghna D.;Singh, Gautam K.
背景：肺动脉加速时间（PAAT）是评价肺血流动力学的一种无创方法，但在儿童中缺乏有效性。本研究的目的是评估多普勒超声心动图衍生的PAAT在预测右心导管（RHC）衍生的肺动脉压（PAP）、肺血管阻力（PVR）和儿童顺应性方面的准确性。预先采集并回顾性测量多普勒超声心动图衍生的PAAT和RHC衍生的收缩期PAP、平均PAP（mPAP）、指数PVR（PVRi），采用回归分析对75名肺血流动力学范围较宽的儿童（中位年龄5.3岁，四分位距1.3-12.6岁）进行了比较。为了解释心率变异性，根据右心室射血时间调整PAAT，并通过RR间期进行校正。然后，在50名年龄和体重匹配的PAP和PVR升高的儿童的验证队列中，评估包含来自推导队列的PAAT和PAAT/右心室射血时间的回归方程对侵入性肺血流动力学的预测值的准确性。PAAT与RHC衍生的mPAP呈显著负相关（r = -0.82）和PVRi（r = -0.78），以及衍生队列中PAAT和肺顺应性之间的直接相关性（r = 0.78）。肺动脉高压（PRVi > 3 Wood units.m（2）和mPAP > 25 mm Hg）的检测，PAAT < 90 msec和PAAT/右心室射血时间< 0.31导致敏感性为97%和特异性为95%。在推导队列中，PAAT与mPAP和PVRi相关的回归方程为mPAP = 48 - 0.28 x PAAT和PVRi = 9 - 0.07 x PAAT。在验证队列中，这些PAAT积分方程预测了RHC测量的肺血流动力学，相关性良好（分别为r = 0.88和r = 0.83），偏倚较小（
Background: Pulmonary artery acceleration time (PAAT) is a noninvasive method to assess pulmonary hemodynamics, but it lacks validity in children. The aim of this study was to evaluate the accuracy of Doppler echocardiography-derived PAAT in predicting right heart catheterization (RHC)-derived pulmonary artery pressure (PAP), pulmonary vascular resistance (PVR), and compliance in children.Methods: Prospectively acquired and retrospectively measured Doppler echocardiography-derived PAAT and RHC-derived systolic PAP, mean PAP (mPAP), indexed PVR (PVRi), and compliance were compared using regression analysis in a derivation cohort of 75 children (median age, 5.3 years; interquartile range, 1.3-12.6 years) with wide ranges of pulmonary hemodynamics. To account for heart rate variability, PAAT was adjusted for right ventricular ejection time and corrected by the RR interval. Regression equations incorporating PAAT and PAAT/right ventricular ejection time from the derivation cohort were then evaluated for the accuracy of their predictive values for invasive pulmonary hemodynamics in a validation cohort of 50 age-and weight-matched children with elevated PAP and PVR.Results: There were significant inverse correlations between PAAT and RHC-derived mPAP (r = -0.82) and PVRi (r = -0.78) and a direct correlation (r = 0.78) between PAAT and pulmonary compliance in the derivation cohort. For detection of pulmonary hypertension (PRVi > 3 Wood units.m(2) and mPAP > 25 mm Hg), PAAT < 90 msec and PAAT/right ventricular ejection time < 0.31 resulted in sensitivity of 97% and specificity of 95%. In the derivation cohort, the regression equations relating PAAT with mPAP and PVRi were mPAP = 48 - 0.28 x PAAT and PVRi = 9 - 0.07 x PAAT. These PAAT-integrated equations predicted RHC-measured pulmonary hemodynamics in the validation cohort with good correlations (r = 0.88 and r = 0.83, respectively), small biases (