Usefulness of right ventricular isovolumic relaxation time in predicting systolic pulmonary artery pressure
Usefulness of right ventricular isovolumic relaxation time in predicting systolic pulmonary artery pressure
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DOI：
10.1093/ejechocard/jen121
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发表时间：
2008-07-01
影响因子：
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通讯作者：
Roudaut, Raymond
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文献类型：
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作者：
Brechot, Nicolas;Gambotti, Laetitia;Roudaut, Raymond
目的 肺动脉收缩压 (sPAP) 不能总是通过多普勒检测到的三尖瓣反流 (TR) 来评估，尤其是当 sPAP 正常时。右心室等容舒张时间 (rIVRT) 与 sPAP 相关，最近提出通过组织多普勒成像 (rIVRT') 评估 rIVRT 作为评估肺动脉高压 (PAH) 患者 sPAP 的替代方法。我们在这里评估了它在日常临床实践中的有用性。方法和结果我们对 26 名患者进行了前瞻性多普勒与导管插入术研究。在 6 名 sPAP 正常患者（32%）和 1 名 PAH 患者（14%）中未检测到 TR。所有患者均可记录 rIVRT'。我们发现 rIVRT' 和 sPAP 之间存在很强的相关性 (r = 0.87；P < 0.0001)。 rIVRT'对检测PAH具有较高的敏感性，rIVRT'为40 ms或更短可以排除PAH，阴性预测值为100%。我们还发现，延长的 rIVRT' 对于 PAH 并不具有特异性，并且 rIVRT' 评估的 sPAP 与导管评估值不太一致。结论 rIVRT' 的测量可以帮助在没有 TR 的情况下估计 sPAP：正常的 rIVRT' 可以排除 PAH，具有较高的阴性预测值。延长 rIVRT' 有利于 sPAP 升高，但不能单独证实这一点。
Aims Systolic pulmonary artery pressure (sPAP) cannot always be assessed from Doppler-detected tricuspid regurgitation (TR), especially when sPAP is normal. The right ventricular isovolumic relaxation time (rIVRT) is related to sPAP, and assessment of rIVRT by tissular Doppler imaging (rIVRT') has recently been proposed as an alternative method for estimating sPAP in patients with pulmonary artery hypertension (PAH). We evaluated here its usefulness in everyday clinical practice.Methods and results We conducted a prospective Doppler vs. catheterization study in 26 patients. TR was undetectable in 6 patients (32%) with normal sPAP and in one patient (14%) from those with PAH. rIVRT' was recordable in all patients. We found a strong correlation between rIVRT' and sPAP (r = 0.87; P < 0.0001). rIVRT' had a high sensitivity in detecting PAH, and a rIVRT' of 40 ms or less excluded PAH with a negative predictive value of 100%. We also found that a prolonged rIVRT' is not specific to PAH and that the rIVRT'-evaluated sPAP did not agree well with the catheter-evaluated value.Conclusion Measurement of rIVRT' can help estimate sPAP in the absence of TR: A normal rIVRT' excludes PAH with a high negative predictive value. A prolonged rIVRT' is in favour of an elevated sPAP but cannot affirm it by itself.