Shape of the Right Ventricular Doppler Envelope Predicts Hemodynamics and Right Heart Function in Pulmonary Hypertension
Shape of the Right Ventricular Doppler Envelope Predicts Hemodynamics and Right Heart Function in Pulmonary Hypertension
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DOI：
10.1164/rccm.201004-0601oc
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发表时间：
2011-01-15
影响因子：
24.7
通讯作者：
Forfia, Paul R.
中科院分区：
文献类型：
--
作者：
Arkles, Jeffrey S.;Opotowsky, Alexander R.;Forfia, Paul R.
理论基础：右室流出道多普勒血流速度包络(FVERVOT)的收缩期减速或“切迹”与肺动脉阻抗升高时的病理波反射有关。目的：我们调查了在转诊的肺动脉高压(PH)队列中，简单的FVERVOT形态评估是否有助于血流动力学鉴别和肺血管疾病的检测。方法：我们回顾了88例PH患者和32例收缩期心衰和PH患者的血流动力学、超声心动图和临床资料。FVERVOT分为正常(无切迹[NN])、收缩晚期切迹(LSN)和收缩中期切迹(MSN)。测量和主要结果：肺血管阻力以MSN组最高(9.2+/-3.5Wood‘s单位[Wu]；P<；0.001)，高于LSN(5.7+/-3.1Wu)和NN(3.3+/-2.4Wu)组。每搏输出量与脉压(顺应性)的比值也有差异(MSN=1.2+/-0.5；LSN=1.7+/-0.8；NN=2.6+/-1.7；P=0.001和0.04，与NN相比)。MSN对PVR>；5Wu的特异性为96%，敏感性为71%(阳性预测值为98%)。与LSN组和NN组相比，MSN组右室功能不全(三尖瓣环平面收缩运动1.6±/-0.5 cm)较LSN组和NN组严重(三尖瓣环平面收缩运动1.9+/-0.6vs.2.2+/-0.6 cm，P均<0.05)。在PH队列中，任何VVERVOT切迹(MSN或LSN)与PVR>；3Wu高度相关(优势比，22.3；95%可信区间，5.2~96.4)，而NN模式预测PVR小于或等于3WU，且肺动脉楔压大于15 mm Hg(优势比，30.2；95%可信区间，6.3~144.9)。结论：目测FVERVOT形状可深入了解转诊PH队列中PH的血流动力学基础。MSN与最严重的肺血管疾病和右心功能障碍有关。
Rationale: Systolic deceleration or "notching" of the right ventricular outflow tract Doppler flow velocity envelope (FVERVOT) relates to pathologic wave reflection in the setting of elevated pulmonary artery impedance.Objectives: We investigated whether simple visual assessment of FVERVOT morphology aids in hemodynamic differentiation and detection of pulmonary vascular disease among a referral pulmonary hypertension (PH) cohort.Methods: We reviewed hemodynamics, echocardiography, and clinical data for 88 patients referred for PH and 32 subjects with systolic heart failure and PH. The FVERVOT was categorized as normal (no notch [NN]); late systolic notch (LSN); or midsystolic notch (MSN). Measurements and Main Results: The pulmonary vascular resistance (PVR) was highest in the MSN group (9.2 +/- 3.5 Wood's units [WU]; P < 0.001) versus the LSN (5.7 +/- 3.1 WU) and NN (3.3 +/- 2.4 WU) groups. The ratio of stroke volume to pulse pressure (compliance) also differed by FVERVOT morphology (MSN = 1.2 +/- 0.5; LSN = 1.7 +/- 0.8; NN = 2.6 +/- 1.7; P = 0.001 and 0.04, respectively, vs. NN). MSN was 96% specific and 71% sensitive for a PVR >5 WU (positive predictive value, 98%). The MSN group had severe right ventricular dysfunction (tricuspid annular plane systolic excursion 1.6 +/- 0.5 cm) relative to the LSN and NN groups (tricuspid annular plane systolic, excursion 1.9 +/- 0.6 vs. 2.2 +/- 0.6 cm; both P < 0.05). In the PH cohort, any FVERVOT notching (MSN or LSN) was highly associated with PVR >3 WU (odds ratio, 22.3; 95% confidence interval, 5.2-96.4), whereas the NN pattern predicted a PVR less than or equal to 3WU and pulmonary artery wedge pressure greater than 15 mm Hg (odds ratio, 30.2; 95% confidence interval, 6.3-144.9).Conclusions: Visual inspection of the shape of the FVERVOT provides insight into the hemodynamic basis of PH in a referral PH cohort. MSN is associated with the most severe pulmonary vascular disease and right heart dysfunction.